Method and apparatus for passing suture

ABSTRACT

A device that can pierce and hold tissue and then pass suture through tissue. The device can have a shuttle that can removably attach to a suture and jaws that can be rotatably opened and closed with respect to each other. The device can have a first jaw having a first jaw channel and a first jaw first stop. The shuttle can have a shuttle longitudinal axis and a shuttle first stop. The shuttle first stop can have a shuttle first stop distal end. The shuttle first stop distal end can be deflectable into the first jaw first stop. When the shuttle first stop distal end is in contact with the first jaw first stop, the shuttle can be passively retained in the first jaw. A method for using the device to repeatedly pass the suture through the tissue without removing the suture or device from the target site.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/733,740 filed Jan. 3, 2020, which is incorporated herein by referencein its entirety for all purposes.

BACKGROUND 1. Field of the Invention

The present invention relates to system, methods, and apparatus forenhancing the advancement and retention of suture through tissue.

2. Description of Related Art

Suturing apparatus in the past have had an elongate shaft and a lowprofile distal clamping mechanism to facilitate their use throughcannulas 226 in less invasive surgery. These devices have typicallyincluded opposing jaws which clamp onto the tissue to be sutured. Theend segment of the suture is pre-positioned and secured at the distalend of one jaw member. Beyond the clamping motion, the mechanism forpassing a suture between the jaws and through the tissue incorporates abendable needle. The bendable needle advances distally within the jawmember, bringing it in contact with a segment of the suture.

The needle engages and secures the suture to carry it forward. Thisdistal advancement of the bendable needle also results in the leadingend of the needle to approach and engage a ramp 44 in the jaw member,deflecting the bendable needle in a direction toward the opposing jaw.The bending of the needle requires a high force and results in excessstrain on the needle component. Fracture and failure of the bendableneedle is a concern.

Additionally, the bendable needle is further advanced after beingdeflected in a direction extending away from the jaws, and potentiallyinto unintended anatomy. Extension of the needle in this manner is asafety concern. Even after the apparatus has completed passing thesuture through the tissue, the end segment of the suture must beretrieved by retracting the entire apparatus out of the cannula.

It would be advantageous to have an apparatus that could load and unloadsuture without the need to remove the apparatus from the surgical site.

It would be advantageous to have an apparatus that could pass (not loadand unload) suture repeatedly through tissue without the need to removethe apparatus from the surgical site. It would also be advantageous forthe suture shuttling mechanism (either needle or shuttle) to be entirelycontained within the apparatus during operation to improve accuracy ofsuture placement and improve safety of needle or shuttle position duringoperation.

SUMMARY OF THE INVENTION

This disclosure relates generally to suture devices and methods ofsuturing.

Suture manipulating devices are disclosed. For example, a suturemanipulating device having a first jaw having a first jaw channel and afirst jaw first stop is disclosed. The suture manipulating device canhave a shuttle. The shuttle can have a shuttle longitudinal axis and ashuttle first stop. The shuttle can be slideable in the first jawchannel. The shuttle first stop can extend away from the shuttlelongitudinal axis. The shuttle first stop can have a shuttle first stopproximal end and a shuttle first stop distal end. The shuttle first stopproximal end can be narrower than the shuttle first stop distal end. Theshuttle first stop distal end can be deflectable into the first jawfirst stop. The shuttle first stop can be engageable with the first jawfirst stop. When the shuttle first stop is engaged with the first jawfirst stop, the shuttle first stop distal end can be in contact with thefirst jaw first stop. When the shuttle first stop distal end is incontact with the first jaw first stop, the shuttle can be passivelyretained in the first jaw.

Suture manipulating devices are disclosed. For example, a suturemanipulating device having a jaw structure having a shuttle channelhaving a shuttle channel first stop is disclosed. The suturemanipulating device can have a shuttle. The shuttle can have a shuttlelongitudinal axis and a shuttle first stop. The shuttle can be slideablein the shuttle channel. The shuttle first stop can extend away from theshuttle longitudinal axis. The shuttle first stop can have a shuttlefirst stop proximal end and a shuttle first stop distal end. The shuttlefirst stop proximal end can be narrower than the shuttle first stopdistal end. The shuttle first stop can be moveable into the shuttlechannel first stop. The shuttle first stop can be engageable with theshuttle channel first stop. When the shuttle first stop is not engagedwith the shuttle channel first stop, the shuttle first stop can have ashuttle first stop non-deflected shape. When the shuttle first stop isengaged with the shuttle channel first stop, the shuttle first stop canhave a shuttle first stop deflected shape.

Suture manipulating devices are disclosed. For example, a suturemanipulating device having a jaw having a shuttle channel having afemale stop is disclosed. The suture manipulating device can have ashuttle. The shuttle can have a shuttle longitudinal axis and a malestop. The shuttle can be translatable in the shuttle channel. The malestop can be engageable with the female stop. The male stop can extendaway from the shuttle longitudinal axis. The male stop can have a malestop proximal end and a male stop distal end. The male stop distal endcan be wider than the male stop proximal end. The male stop can betranslatable into and out of the female stop. The male stop can bedeflectable into and out of the female stop.

BRIEF DESCRIPTION OF THE FIGURES

The drawings shown and described are exemplary embodiments andnon-limiting. Like reference numerals indicate identical or functionallyequivalent features throughout.

FIGS. 1a, 1b and 1c are perspective, top and side views, respectively,of a variation of the suture passing device.

FIGS. 2a and 2b are a distant and close-up view, respectively, of avariation of the shuttle in a straight configuration.

FIG. 2c is a close-up view of the variation of the shuttle from FIGS. 2aand 2b in a curved configuration.

FIG. 3a is a close-up, perspective, partial see-through view of thedistal end of a variation of the suture passing device attached to alength of a suture.

FIG. 3b is a close-up view of a portion of FIG. 3 a.

FIGS. 4a and 4b are close-up perspective and side views, respectively,of the distal end of a variation of the suture passing device in aclosed configuration.

FIG. 4c is a close-up of the distal end of FIGS. 4a and 4 b.

FIG. 4d is a close-up perspective view of the distal end of the deviceof FIG. 4a in a closed configuration.

FIG. 5 is a variation of cross-section A-A of FIG. 1a with the deviceattached to a length of a suture.

FIGS. 6a through 6d illustrate a variation of a method of using avariation of the suture passing device to create a stitch in a piece oftissue.

FIGS. 7a and 7b are a side perspective view and a close-up a variationof the device with an exploded view of a shuttle, and a close-up of theproximal end of the device, respectively.

FIG. 7c is a close-up view of the variation of the shuttle in FIG. 7 a.

FIG. 7d is a close-up view of the distal end of the variation of thedevice shown in FIG. 7 a.

FIG. 8a illustrates a variation of the shuttle.

FIG. 8b illustrates a close-up view of a variation of the distal end ofthe device.

FIGS. 9a and 10a are side perspective and partial see-through sideperspective views, respectively, of a variety of the device in an openedconfiguration.

FIGS. 9b and 11a are side perspective and side cross-section views,respectively, of a variety of a method for closing the jaws of thedevice of FIG. 9 a.

FIGS. 9c and 11b are a close-up view and a side see-through view,respectively, of the distal end of the device in FIG. 9 b.

FIG. 10b is a close-up partial see-through view of the distal end of thelower jaw of FIG. 10 a.

FIGS. 12a through 12c are side, top and bottom views, respectively, of avariation of the shuttle.

FIGS. 13a and 13b illustrate variations of the shuttle.

FIGS. 14a through 14c are top end, front perspective, and bottomperspective views, respectively, of a variation of the shuttle.

FIGS. 15a through 15c are side perspective, bottom perspective, andside-bottom perspective views of a variation of the shuttle.

FIGS. 16a and 16b are top perspective and side perspective views of avariation of the shuttle.

FIG. 17a illustrates a variation of the device with the shuttle of FIGS.12a through 12 c.

FIG. 17b illustrates a variation of the device of FIG. 17a with apusher.

FIGS. 17c and 17d illustrate a variation of the device of FIG. 17a withtwo pushers in different configurations.

FIGS. 18a and 18b are side perspective and side views, respectively, ofa variation of the distal end of the device.

FIGS. 19a and 19b are side perspective and side views, respectively, ofa variation of the distal end of the device.

FIGS. 20a and 20b are side perspective and side views, respectively, ofa variation of the distal end of the device.

FIGS. 21a and 21b are side perspective and side views, respectively, ofa variation of the distal end of the device.

FIGS. 22a and 22b illustrate a variation of the distal end and distallower jaw, respectively, of the device.

FIG. 22c is a side view of the device of FIG. 22a with a shuttle.

FIGS. 23a and 23b are a variation of the distal end of the device inopen and closed configurations, respectively with the device of FIG. 23bhaving a shuttle.

FIGS. 24a through 24c are side perspective, side and distal end views,respectively, of a variation of the device.

FIGS. 25a through 25f are bottom and side perspective, partialsee-through (the upper jaw is see-through), longitudinal cross-section,partial cut-away close-up, and partial cut-away views, respectively, ofthe distal end of a variation of the device with the jaws in an openedconfiguration with the shuttle and pushers in various positions, andwith the compression cover not shown in FIG. 25f for illustrativepurposes.

FIG. 26a is a side perspective view of a variation of the distal end ofdevice with the jaws in a closed configuration with the shuttle in theupper jaw and not engaged in the lower jaw.

FIGS. 26b and 26c are longitudinal cross-section and side perspectiveviews, respectively, of the device of FIG. 26a with the shuttle in thetop and bottom jaws. FIG. 26 b does not show the pushers forillustrative purposes.

FIG. 26d is a partial cut-away view of FIG. 26 c.

FIG. 27 is a close-up, partial cut-away view of the distal end of avariation of the device with the shuttle in the lower jaw and the upperpusher extending out of the upper jaw and partially entering the lowerjaw.

FIG. 28 is a close-up end perspective view of a variation of the devicewith the shuttle and suture of FIG. 13a or 13 b.

FIG. 29 is a close-up end perspective view of a variation of the devicewith the shuttle and suture of FIGS. 14a through 14 c.

FIGS. 30a and 30b are right rear, and left cut-away views, respectively,of a variation of the device.

FIG. 31 is a partially cut-away and partially see-through view of theproximal end of a variation of the device.

FIGS. 32a and 32b are left and right perspective views of a variation ofthe pusher drive gears of the device.

FIG. 33A illustrates a variation of the shuttle in a lower jaw with halfthe lower jaw shown transparent.

FIG. 33B illustrates a variation of the shuttle in a lower jaw with halfthe lower jaw shown transparent.

FIG. 34A illustrates a variation of the shuttle in an upper jaw withhalf the upper jaw shown transparent.

FIG. 34B illustrates a variation of the shuttle in an upper jaw withhalf the upper jaw shown transparent.

FIG. 35 illustrates a variation of the device with half the lower andupper jaws shown transparent.

FIG. 36A illustrates a perspective view of a variation of a shuttle.

FIG. 36B illustrates a bottom view of the shuttle of FIG. 36A.

FIG. 36C illustrates a side view of the shuttle of FIG. 36A.

FIG. 37A illustrates a top or bottom view of a variation of a shuttle.

FIG. 37B illustrates a top or bottom view of a variation of a shuttle.

FIG. 37C illustrates a top or bottom view of a variation of a shuttle.

FIG. 37D illustrates a top or bottom view of a variation of a shuttle.

FIG. 37E illustrates a top or bottom view of a variation of a shuttle.

FIG. 38A illustrates a perspective view of a variation of a shuttle.

FIG. 38B illustrates a bottom view of the shuttle of FIG. 38A.

FIG. 38C illustrates a side view of the shuttle of FIG. 38A.

FIG. 39A illustrates a side view of a variation of a pusher.

FIG. 39B illustrates a side view of a variation of a pusher.

FIG. 39C illustrates a side view of a variation of a pusher.

FIG. 39D illustrates a side view of a variation of a pusher.

FIG. 40A illustrates a perspective view of the pusher of FIG. 39A havinga shuttle seat.

FIG. 40B illustrates a perspective view of the pusher of FIG. 39B havinga shuttle seat.

FIG. 40C illustrates a perspective view of the pusher of FIG. 39C havinga shuttle seat.

FIG. 40D illustrates a perspective view of the pusher of FIG. 39D havinga shuttle seat.

FIG. 41A illustrates a top or bottom view of a variation of a pusher.

FIG. 41B illustrates a top or bottom view of a variation of a pusher.

FIG. 41C illustrates a top or bottom view of a variation of a pusher.

FIG. 41D illustrates a top or bottom view of a variation of a pusher.

FIG. 41E illustrates a top or bottom view of a variation of a pusher.

FIG. 41F illustrates a top or bottom view of a variation of a pusher.

FIG. 42A illustrates a variation of a pusher.

FIG. 42B illustrates a variation of a pusher.

FIG. 42C illustrates a variation of a pusher.

FIG. 42D illustrates a variation of a pusher component.

FIG. 43A illustrates a variation of the upper and lower jaws.

FIG. 43B illustrates a variation of the upper and lower jaws.

FIG. 43C illustrates a variation of the upper and lower jaws.

FIG. 43D illustrates a variation of the upper and lower jaws.

FIG. 43E illustrates a variation of the upper and lower jaws.

FIG. 43F illustrates a variation of the upper and lower jaws.

FIG. 43G illustrates a variation of the upper and lower jaws.

FIG. 43H illustrates a variation of the upper and lower jaws.

FIG. 43I illustrates a variation of the upper and lower jaws.

FIG. 43J illustrates a variation of the upper and lower jaws.

FIG. 43K illustrates a variation of the upper and lower jaws.

FIG. 43L illustrates a variation of the upper and lower jaws.

FIG. 43M illustrates a variation of the upper and lower jaws.

FIG. 43N illustrates a variation of the upper and lower jaws.

FIG. 44A illustrates a side view of a variation of the device with halfthe device shown transparent.

FIG. 44B illustrates a perspective view of the device of FIG. 44A.

FIG. 45A illustrates a variation of the device.

FIG. 45B illustrates a variation of the device.

FIG. 45C illustrates a variation of a handle of the device.

FIG. 45D illustrates a variation of a handle of the device.

FIG. 45E illustrates a variation of a handle of the device.

FIG. 45F illustrates a variation of a handle of the device.

FIG. 45G illustrates a variation of a handle of the device.

FIG. 45H illustrates a variation of a handle of the device.

FIG. 45I illustrates a variation of a handle of the device.

FIG. 45J illustrates a variation of a handle of the device.

FIG. 45K illustrates a variation of a handle of the device.

FIG. 45L illustrates a variation of a handle of the device.

FIG. 45M illustrates a variation of a handle of the device.

FIG. 46A illustrates a variation of a tube of the device.

FIG. 46B illustrates a variation of an upper pusher.

FIG. 46C illustrates a variation of a lower pusher.

FIG. 46D illustrates a variation of a tube of the device.

FIG. 46E illustrates a variation of a compression cover.

FIG. 46F illustrates a variation of a first side of the lower jaw.

FIG. 46G illustrates a variation of a second side of the lower jaw.

FIG. 46H illustrates a variation of a first side of the upper jaw.

FIG. 46I illustrates a variation of a second side of the upper jaw.

FIG. 46J illustrates a variation of a connector.

FIG. 46K illustrates pins for the connector of FIG. 46J.

FIG. 47A illustrates a variation of the lower jaw and various componentsin the lower jaw with half of the lower jaw shown transparent.

FIG. 47B illustrates a variation of the lower jaw and various componentsin the lower jaw with half of the lower jaw shown transparent.

FIG. 47C illustrates a variation of the upper jaw and various componentsin the upper jaw with half of the upper jaw shown transparent.

FIG. 47D illustrates a variation of the upper jaw and various componentsin the upper jaw with half of the upper jaw shown transparent.

FIG. 47E illustrates a variation of the device with half the lower andupper jaws shown transparent.

FIG. 47F illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47G illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47H illustrates a perspective view of a variation of a shuttlestop.

FIG. 47I illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47J illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47K illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47L illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with half of the upperand/or lower jaw shown transparent.

FIG. 47M illustrates a variation of a shuttle and a shuttle stopcontroller.

FIG. 47N illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw.

FIG. 47O illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with the upper and/orlower jaw shown transparent.

FIG. 47P is a perspective view of FIG. 47N.

FIG. 47Q illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw.

FIG. 47R illustrates a variation of the upper and/or lower jaw withvarious components in the upper and/or lower jaw with the upper and/orlower jaw shown transparent.

FIG. 47S is a perspective view of FIG. 47Q.

FIG. 47T is a side view of a variation of the device.

FIG. 47U is a side view of a variation of the device.

FIG. 47V is a side view of a variation of the device.

FIG. 47W is a side view of a variation of the device.

FIG. 48A illustrates a variation of the device having a piercer.

FIG. 48B illustrates a variation of the device having a piercer.

FIG. 48C illustrates a variation of the device having a piercer.

FIG. 48D illustrates a variation of the device having a piercer.

FIG. 48E illustrates a variation of the device having a piercer.

FIG. 48F illustrates a variation of the device having a piercer.

FIG. 48G illustrates a variation of the device having a piercer.

FIG. 48H illustrates a variation of the device having two piercers.

FIG. 48I illustrates a variation of the device having two piercers.

FIG. 49A illustrates a perspective view of a variation of a shuttle.

FIG. 49B is a magnified view of the shuttle of FIG. 49A at section49B-49B (the square box in dashed lines).

FIG. 49C illustrates a perspective view of the shuttle of FIG. 49A withsuture attached.

FIG. 49D illustrates a bottom view of the shuttle of FIG. 49A.

FIG. 49E illustrates a side view of the shuttle of FIG. 49A.

FIG. 49F illustrates a top view of the shuttle of FIG. 49A in a flatconfiguration.

FIG. 49G illustrates a side view of the shuttle of FIG. 49F.

FIG. 49H ₁ illustrates the shuttle of FIG. 49A in an upper jaw with halfof the upper jaw shown transparent.

FIG. 49H ₂ illustrates the shuttle of FIG. 49A in a lower jaw with halfof the lower jaw shown transparent.

FIG. 49H ₃ illustrates a variation of the device with the shuttle ofFIG. 49A in the upper jaw with half of the lower and upper jaws showntransparent.

FIG. 49H ₄ illustrates a variation of the device with the shuttle ofFIG. 49A in the lower jaw with half of the lower and upper jaws showntransparent.

FIG. 50A illustrates a top view of a variation of a shuttle in a flatconfiguration.

FIG. 50B illustrates a side view of the shuttle of FIG. 50A in a shapeset configuration.

FIG. 50C illustrates an end view of the shuttle of FIG. 50B.

FIG. 50E illustrates a top view of a variation of the shuttle of FIG.50B and a variation of a lower jaw pusher in a lower jaw shuttle trackwith the lower jaw shuttle track shown transparent.

FIG. 50D illustrates a top view of a variation of the shuttle of FIG.50B and a variation of an upper jaw pusher in an upper jaw shuttle trackwith the upper jaw shuttle track shown transparent.

FIG. 50F illustrates a top view of a variation of the shuttle of FIG.50B and a variation of a lower jaw pusher in a lower jaw shuttle trackwith a top of the lower jaw shown transparent.

FIG. 50G illustrates a top view of a variation of the shuttle of FIG.50B and a variation of an upper jaw pusher in an upper jaw shuttle trackwith a top of the upper jaw shown transparent.

FIG. 50H ₁ illustrates a perspective view of a variation of a lower jawwith half of the lower jaw shown transparent.

FIG. 50H ₂ illustrates a perspective view of the lower jaw of FIG. 50H ₁with a variation of a shuttle and with half of the lower jaw showntransparent.

FIG. 50H ₃ illustrates a perspective view of a variation of an upper jawwith half of the upper jaw shown transparent.

FIG. 50H ₄ illustrates a perspective view of the upper jaw of FIG. 50H ₄with a variation of a shuttle and with half of the upper jaw showntransparent.

FIGS. 51A-51L illustrate top views of variations of shuttles andvariations of male stops.

FIG. 52A is a perspective view of a variation of a male stop.

FIG. 52B is a side view of a lower jaw and a side view of an upper jawwith the male stop of FIG. 52A in a disengaged configuration, with theupper jaw shown transparent.

FIG. 52C is a side view of the upper jaw of FIG. 52B with the male stopin an engaged configuration.

FIG. 52D is a close-up of FIG. 52C without a shuttle or a male stop.

FIG. 52E is a close-up perspective view of FIG. 52B.

DETAILED DESCRIPTION

FIGS. 1a through 1c illustrate a suture passing device 188 that can beused to pass suture 70 through soft or hard tissue 74 without removingthe device 188 or the suture 70 from the target site while creating oneor more complete stitches.

The suture passing device 188 can have an ergonomic handle 104, asliding tube actuator 6, and a distal end 2. The ergonomic handle 104can be used to control the distal end 2. The ergonomic handle 104 canhave a side knob 10. The ergonomic handle 104 can have a top knob 12.The top knob 12 and/or the side knob 10 can individually or in concert,advance and/or retract the upper 86 and/or lower pusher 76.

The sliding tube actuator 6 can have an outer compression cover 34 andan inner rod (not shown due to obstruction by the outer compressioncover 34). The inner rod can be fixedly attached to the handle 104 andthe proximal end of the jaw structure 28. The outer compression cover 34can be radially outside of the inner rod. The outer compression cover 34can be actuated by the handle 104, for example be distally andproximally translated with respect to the handle 104 when the trigger 8is squeezed or released.

FIGS. 2a and 2b illustrate that the device 188 can have a sliding ribbonshuttle 14 or needle held within the device 188. The shuttle 14 can havean elongated shuttle rail 16. The shuttle rail 16 can have numerousslits 20 along one or both sides of the shuttle rail 16. The slits 20can be positioned at regular or irregular length intervals along therail 16.

The shuttle 14 can have a suture holder 18 extending laterally from therail 16. The shuttle 14, for example the suture holder 18, can extendout of the lateral side slot 72 of the arm structure. The suture holder18 can extend from the left and/or right side of the device 188. Thedistal end 2 of the device 188 can be reversible so the suture holder 18can be switched from one side of the device 188 to the other side of thedevice 188. The suture holder 18 can have a generally flat, isoscelestrapezoid configuration. The suture holder 18 can have a suture holdingnotch 100. The notch 100 can have an inner hole 17 a, an outer hole 17 bcontiguous with the inner hole 17 a, and a first cleat 97 a positionedbetween the inner hole 17 a and the outer hole 17 b. The notch 100 canhave a second cleat 97 b on the side of the outer hole away from theinner hole. The notch 100 can be configured to secure to suture 70. Forexample, the suture 70 can be compressed and friction fit in the innercleat 97 a.

The suture holder 18 can have a front leading edge and a rear leadingedge. The edges can be slanted at a right or non-right angle withrespect to the longitudinal axis of the rail 16. One or both of theedges can be sharpened to be traumatic to tissue 74, for example to cutthrough soft tissue 74. The edges can cut through tissue 74, allowingthe suture holder 18 to pull the suture 70 through the tissue 74immediately behind the respective edge.

The shuttle 14 can be made from a flexible polymer, such as PEEK, aresilient metal such as Nitinol, any material disclosed herein orcombinations thereof. The shuttle 14 can be made from a molded polymer.The shuttle 14 can be pre-curved, for example to reduce resistance whengoing around curves in the tracks.

FIG. 2c illustrates that the rail 16 can curve at the locations of theslits 20, and/or the rail 16 can be pre-curved.

FIGS. 3a and 3b illustrate that the suture passing device 188 cancapture or releasably attach to the suture 70 in the inner and/or outercleats 97 a and/or 97 b of the suture holder 18. The suture 70 can beloaded or held laterally of the jaw structure 28, out of plane with therotation of the jaws. The device 188 can make multiple passes of thesuture 70 through the tissue 74 without extracting or reloading thesuture passing device 188. The jaw structure 28 can resiliently deformopen at the proximal end of the jaw structure 28, having no hinge. Thejaws can be opened and/or closed with no mechanical pivots or linkagesin the jaw structure 28.

FIG. 4a illustrates that the suture passer device 188 can have a jawstructure 28 with a top jaw 30 and a bottom jaw 38. The entire jawstructure 28 can be an integral piece of material, such as a singlemolded, cast, or cut element of Nitinol, other resilient metal orpolymer, any other material listed herein, or combinations thereof. Thejaw structure 28 can be configured to be in an opened configuration (asshown in FIG. 4d ) when in an unbiased configuration (i.e., when noexternal forces are applied).

The jaw structure 28 can have a jaw structure longitudinal axis 42. Eachjaw can also have a respective jaw longitudinal axis along the jaw.

The inside channel of the compression cover 34 can be sized and shapedto fit over the jaw structure 28 with minimum clearance when the jawstructure 28 is in a closed configuration. When the compression cover istranslated distally 138 with respect to the jaw structure 28, as shownby arrow, the compression cover 34 can press the top and bottom jaws 38toward the jaw structure longitudinal axis 42. The jaw structure 28 canbe fully compressed into a closed configuration, as shown in FIGS. 4athrough 4c . In this way, when an actuation lever such as the trigger 8is actuated, the channel or compression cover 34 can advance to camclosed the jaws. The jaws can pre-pierce the tissue and establish acontinuous track for the shuttle to pass through the tissue.

The compression cover 34 can be attached to an opening ball 32positioned between the first and second jaws.

FIG. 4b illustrates that the opening ball 32 can be rotatably or fixedlyattached to a ball axle 52 passing laterally through the opening ball32. The ball axle 52 can extend out from the lateral sides of the ball32. The ball axle 52 can be slidably received by axle slots 50 formedthrough distal arms 54 or extensions 138 of the compression cover 34.When the jaw structure 28 is in a closed configuration, the ball axle 52can abut and interference fit against the proximal end of the axle slot50, for example to prevent overextension of the compression cover 34over the jaw structure 28. When the jaw structure 28 is in an openedconfiguration, the ball axle 52 can abut and interference fit againstthe distal end 2 of the axle slot 50, for example to preventoverrotation of the jaws and/or pulling the ball 32 past the ramps 44 onthe inside of the jaw structure 28.

FIG. 4c illustrates that the bottom track 66 can distally terminate in abottom track port 62. The top track 64 can distally terminate at a toptrack port 60. The top track port 60 can align with and be adjacent to(as shown) or in contact with the bottom track port 62 when the jawstructure 28 is in a closed configuration with the first jaw tip 46interdigitating with the second jaw tip 48. The tracks of the upper jaw78 and bottom jaw 38 can form a continuous path when the jaw structure28 is in a closed configuration. The first jaw tip 46 can interdigitatewith and be adjacent or in contact with the second jaw tip 48 when thejaw structure 28 is in a closed configuration.

FIG. 4d illustrates that that compression cover 34 can be translatedproximally 126, as shown by arrow, with respect to the jaw structure 28.The ball axle 52 can slide to the distal end 2 of the axle slot 50. Theaxle slot 50 can then pull the ball axle 52, and therefore the openingball 32, proximally. The opening ball 32 can then press against theinside surface ramp 44 of the first jaw and/or second jaw. The first jawtip 46 and/or second jaw tip 48 can then rotate away from the opposingjaw tip. The jaw structure 28 can then be in an opened configuration, asshown.

The proximal ends of the jaws can be rigid or flexible, for example tobend around the opening of the compression cover 34 when the jaws are inan opened configuration. The entire jaws or just the proximal ends ofthe jaws can be made from Nitinol, for example with the distal ends ofthe jaws made from stainless steel.

FIG. 5 illustrates that the side slot 72 can extend laterally from oneside of the tracks. The rail 16 of the shuttle 14 can be taller than theheight of the side slot 72. The rail 16 can be too large to pass throughthe side slot 72. The suture holder 18 can extend laterally from therail 16 through the side slot 72. The suture holder 18 can hold thesuture 70 laterally spaced away from the jaw.

FIG. 6a illustrates that the upper jaw 78 and the lower jaw 80 can beclosed, as shown by arrows, and compressed through tissue 74, such assoft tissue 74 in the rotator cuff or other joint. The upper jaw tip 206and/or the lower jaw tip 198 can pierce the tissue 74. The upper jaw tip206 and the lower jaw tip 198 can interdigitate in or adjacent to thetissue 74. The hole created by the touching or interdigitating of theupper jaw tip 206 and/or the lower jaw tip 198 can be a hole in thetissue 74 through which the shuttle 14 and/or suture 70 can pass. Thecompression cover can be pushed distally 138 to further compress thefirst jaw toward the second jaw, for example to force the jaw tips topierce the tissue 74.

The lower pusher 76 can be advanced distally, as shown by arrow, ascontrolled by the handle 104. The lower pusher 76 can force or push theshuttle 14 through the track to move distally and to carry the suture 70with the shuttle 14.

FIG. 6b illustrates that the lower pusher 76 can continue to be pushedby the handle 104. The lower pusher 76 can push the shuttle 14 throughthe tissue 74. The front edge 22 of the suture holder 18 can cut throughthe tissue 74 and the suture holder 18 can pull the suture through thecut created in the tissue 74 by the front edge 22 and/or through thepiercing created in the tissue 74 by the tips of the jaw. The pusher andthe shuttle 14 can move along the longitudinal axis of the jaws.

The shuttle 14 can then be positioned entirely in the track of the upperjaw 78. The lower pusher 76 can then be withdrawn from the track of theupper and/or lower jaw 80, and/or the lower pusher 76 can be left inplace but the resistive force can be removed, allowing the lower pusher76 to slide freely in the tracks.

FIG. 6c illustrates that the compression cover can then be translatedproximally 126 (e.g., by releasing or squeezing the trigger 8), as shownby arrow 83. The ball axle 52 can be pulled proximally, forcing theopening ball 32 against the inner surface of the top and/or bottom jaws38. The opening ball 32 can thus resiliently force open the top and/orbottom jaw 38. The jaws can then be unclamped (i.e., rotated open, asshown by arrows 82), and be cleared from the tissue 74.

The device 188 can then be shifted to a position where the distal end 2of the device 188 is adjacent (e.g., lateral) to where the sutureinitially passed through the tissue 74.

FIG. 6d illustrates that the jaw can then be closed, piercing the tissue74 adjacent to the first passage of the suture 70 through the tissue 74.The upper pusher 86 can then be forced distally, as shown by arrow, bythe handle 104. The upper pusher 86 can force or push the shuttle 14along the track in the reverse direction from shown in FIGS. 6a and 6b .The rear edge 24 of the suture holder 18 can then cut the tissue 74 asthe suture holder 18 passes through the tissue 74, carrying the suture70 through the tissue 74. Thus a mattress stitch of the suture 70through the tissue 74 can be created.

The shuttle 14 can then be in the home position, as shown in FIG. 6a .The upper pusher 86 can then be withdrawn from the track of the upperand/or lower jaw 80, and/or the upper pusher 86 can be left in place butthe resistive force can be removed, allowing the upper pusher 86 toslide freely in the tracks. The jaws can be reopened and repositioned,and the device 188 can create another stitch repeating the method shownin FIGS. 6a through 6d . The jaws can be reopened and removed from thetarget site when the stitching is complete or to deliver a secondstitch.

FIG. 7a illustrate that the device 188 can have a base 102 and a handle104 extending from the base 102. The device 188 can have a rotatablelever 106 rotatably attached to the base 102 or handle 104. The device188 can have a compression cover 34 translatably attached to andextending distally from the base 102.

The distal end 2 of the device 188 can have the upper and lower jaws 80.The upper jaw 78 can be rotatable with respect to the lower jaw 80 andvice versa.

The compression cover 34 can be slidably attached to one or both jaws.The rotatable lever 106 can be attached to the compression cover 34. Forexample, squeezing and rotating the lever 106 toward the handle 104 canpush the compression cover distally 138 with respect to the jaws. Thecompression cover can distally slide over the jaws, rotating the upperjaw 78 toward the lower jaw 80 and closing the jaws. The lever 106 canbe spring loaded to rotate away from the handle 104, proximally retractthe compression cover 126, and return the jaws to an open configurationwhen external pressure or squeezing is no longer applied to the lever106.

FIG. 7b illustrates that a pusher shaft or button can extend distallyfrom the base 102 or handle 104. The pusher shaft or button can betranslated with respect to the base 102 and/or handle 104, as shown byarrows. The pusher shaft can be configured to push and/or pull one orboth pushers. Pressing or pulling on the pusher shaft can translate thepusher. A single pusher shaft or button can be toggled between bothpushers.

A pusher toggle, such as a side paddle 112 can extend from the lateralside of the base 102. The side paddle 112 can be positioned on the topor bottom of the base 102 or the handle 104. The side paddle 112 canrotate 110 with respect to the base 102, as shown by arrow. The sidepaddle 112 can be configured to orient the pusher shaft or button totranslate the upper pusher 86 or lower pusher 76 depending on theposition of the side paddle 112.

The device 188 can have a lever 106 lock 120. The lever 106 lock 120 canextend laterally from the base 102. The lock 120 can rotate 118, asshown by arrows, with respect to the base 102. The lock 120 can beconfigured to fix or secure the lever 106 closed or in a particularangular position with respect to the base 102. For example, the lever106 lock can fix the lever 106 closed, in turn fixing the jaws in aclosed configuration.

FIG. 7c illustrates that the shuttle 14 can have a rail 16 that can be acylindrical tube or sleeve. The rail 16 can be made from Nylon, othermaterials disclosed herein, or combinations thereof. The rail 16 canhave rounded (e.g., hemi-spherical) or flat terminal longitudinal ends.

The shuttle 14 can have a suture holder 18 that can be a wire loop 98extending laterally from the rail 16. The wire loop 98 can have a wire.The wire loop 98 can extend in a flat plane. The terminal ends of thewire can be anchored—e.g., removably or fixedly attached to the rail 16,for example through a port or slot in the lateral side of the rail 16.The suture 70 can extend through and remain within the area defined bythe perimeter of the wire loop 98 while the suture 70 is retained by thesuture 70 passer.

FIG. 7d illustrates that the lower jaw 80 (as shown) and/or upper jaw 78can have one or more loading notches or docks 96. The loading dock 96can expose the suture holder 18, such as the wire loop 98, for suture 70loading/unloading. The suture holder 18 can extend into the loadingnotch. For example the wire loop 98 can extend through the side slot 72and into the holding notch 100 with the shuttle 14 is in a position forloading and/or unloading the suture 70 to and/or from the shuttle 14.For example, the shuttle 14 can be at the proximal-most position for theshuttle 14 on the bottom track 66 when the suture holder 18 is alignedwith the loading dock 96. The side slot 72 can terminate at the loadingdock 96, for example, interference fitting the wall of the loading dock96 against the shuttle 14 and/or suture holder 18 to prevent furthertranslation of the shuttle 14 proximally along the jaw.

The lower 80 and/or upper jaws 78 can have a septum 90 can cover amedial terminal face at the distal end 2 of the lower jaw 80 (as shown)and/or upper jaw 78. The septum 90 can be a flexible material that canbe configured to seal around all or part of the shuttle 14 as theshuttle 14 passes through the septum 90. For example, the septum 90 canbe made from a fabric, or a solid panel of polymer such as polyurethaneor polyester.

The septum 90 can have a septum rail port 92. The septum rail port 92can be aligned with the terminal end of the bottom track 66 and/or toptrack 64.

The septum 90 can have a septum slot 94. The septum slot 94 can bealigned with the side slot 72 of the bottom track 66 and/or the uppertrack 264.

The septum 90 can be configured to wipe or squeegee debris, such astissue 74 and biological fluids, from the shuttle 14 as the shuttle 14passes through the septum 90, for example to prevent or minimize debrisand fluids entering the top and/or bottom tracks 66.

FIG. 8a illustrates that the shuttle 14 can have a rail 16 that can havea cylinder and suture holder 18 can be as described in FIGS. 2b and 2c .The holding notch 100 can have angular cleats 97. The holding notch 100can extend to side of the rail 16.

FIG. 8b illustrates that the shuttle 14 can be positioned so the holdingnotch 100 of the suture holder 18 can be in the loading dock 96 when thesuture 70 is attached to or removed from the holding notch 100. Thesuture 70 can be pressed into (e.g., for attaching) or pulled from(e.g., for removing, detaching or repositioning) the holding notch 100.A longitudinally opposing pair of first cleats 97 can laterally frictionfit or interference fit the suture 70 in the holding notch 100. Alongitudinally opposing pair of second cleats 97 can medially frictionfit or interference fit the suture 70 in the holding notch 100 (i.e.,the suture 70 can be radially fixed between the pair of first cleats 97on a lateral side of the suture 70 and the pair of second cleats 97 on amedial side of the suture 70).

The suture 70 can be radially fixed between a pair of longitudinallyopposed cleats 97 that can dig into and compress or puncture theexternal surface of the suture 70.

The shuttle 14 can interference fit or otherwise be stopped by the lowerjaw 80 from moving proximal to a position where the holding notch 100 isexposed in the loading dock 96.

FIGS. 9a, 10a and 10b illustrate that the device 188 can be in an openconfiguration with the upper jaw 78 positioned rotated away from thelower jaw 80. The upper jaw 78 can have an upper jaw longitudinal axis.The lower jaw 80 can have a lower jaw longitudinal axis 132. The lowerjaw longitudinal axis 132 (as shown) or the upper jaw longitudinal axis124 can be parallel and/or collinear with the compression coverlongitudinal axis. The upper law longitudinal axis 124 and the lower jawlongitudinal axis 132 can intersect at a jaw angle 128. When the jawsare in an open configuration, the jaw angle 128 can be from about 30° toabout 45°, more narrowly from about 30° to about 40°.

The compression cover 34 can be translated and retracted proximally, asshown by arrow 126, away from the jaws. The upper jaw 78 can have a slotslide pin 130 that can extend laterally from one or both lateral sidesof the proximal end of the upper jaw 78.

The distal end 2 of the compression cover 34 can have one or more rampslots 134 on one or both lateral sides of the compression cover 34. Theramp slot 134 can narrow as the ramp slot 134 extends proximally (i.e.,widen as the ramp slot 134 extends distally). The ramp slot 134 can beat a non-zero angle (i.e., non-aligned) to the longitudinal axis of thecompression cover 34.

The slot slide pin 130 can be configured to extend through the ramp slot134. The slot slide pin 130 can slide within the ramp slot 134. The slotslide pin 130 can friction fit into the narrower, proximal end of theramp slot 134, for example friction-fitting the jaws in a closedconfiguration and providing tactile feedback to the user of the jawangle 128.

FIG. 10a illustrates that the upper track can pass through a hinge tube149 where is extends past the distal opening of the compression cover 34and into the upper jaw. The hinge tube 149 can be made from nitinol, forexample. The hinge tube 149 can flex when the upper jaw is rotated. Thehinge tube 149 can be an integrated length of the entire upper track, orcan be a separate length of tube attached on one or each end to theremainder of the upper track.

FIGS. 9b and 11a illustrate that the compression cover 34 can bedistally extended or advanced, as shown by arrow 138, with respect tothe jaws. The compression cover 34 can force the jaws to rotate towardeach other to a closed configuration. For example, the upper jaw 78 canrotate, as shown by arrow 136, while the lower jaw 80 remains in arotationally fixed position with respect to the compression cover 34, orvice versa, or the jaws can both rotate with respect to the compressioncover 34. Thus, a lever, such as the trigger 8, can be actuated toadvance the outer tube or compression cover 34 to cam closed the jaws.

When the jaws are in a closed configuration, the jaw angle 128 can befrom about 0° to about 3°, more narrowly from about 0° to about 2°, forexample about 0°.

FIGS. 9c and 11b illustrate that the upper jaw tip 206 can be pressedinto and through the septum rail port 92. The top or upper track 264 canform a continuous lumen 152 with the bottom or lower track 148, forexample, that the shuttle 14 can slide through.

A side slot 72 of upper jaw 78 can align with a side slot 72 of lowerjaw 80. The suture holder 18 can extend through the side slot 72 andhold the suture 70 in the side slot 72. The suture holder 18 cantranslate suture 70 back and forth between the upper 78 and lower jaws80 in the side slot 72 as the shuttle 14 is translated back and forthbetween the upper 78 and lower jaws 80.

FIGS. 12a through 12c illustrate that the shuttle 14 can a rail 16, forexample a shuttle spine 160, and shuttle 14 lateral arms or fingersextending laterally and/or inwardly from the shuttle spine 160. Theshuttle fingers 156 can extend laterally, downwardly, and medially withrespect to the shuttle spine 160, as shown. The shuttles 14 can haveslits 20 or shuttle lateral slots 158 between the shuttle fingers 156.The shuttle fingers 156 can be flexible or rigid.

The shuttle 14 can have a shuttle longitudinal axis 157 (also referredto as the shuttle longitudinal axis 14 _(A1)). The shuttle longitudinalaxis 157 can be flat or curved, for example have a shuttle radius ofcurvature 154 from about 3 mm to about 5 mm, more narrowly from about 3mm to about 4 mm, for example about 3.5 mm.

The shuttle spine 160 can be flexible or rigid. The shuttle 14 can bemade from a single panel of material (e.g., metal), for example bybending and laser cutting the panel.

The suture holders 18 can be one, two or more circular, oval, orotherwise elongated, longitudinal slots in the shuttle spine 160. Forexample, the suture 70 can extend through one or both suture holders 18.The suture 70 can be fused to the shuttle 14 adjacent to the sutureholders 18. A detachable or fixed frame can be attached to the slots inthe shuttle 14 and the suture 70 can be attached to the detachableframe. For example, the detachable frame can be an arc-shaped wireattached at a first end to a first slot in the shuttle spine 160 and ata second end to the adjacent second slot in the shuttle spine 160.

FIG. 13a illustrates that the suture holder 18 can be an arc integralwith the shuttle spine 160. For example, the shuttle 14 can be made froma single panel of material (e.g., metal). The lateral sides of thesuture holder 18 can be cut, and the longitudinal ends can remainintegrated with the shuttle spine 160. The suture holder 18 can then bebent or otherwise deformed away from the plane of the shuttle spine 160,for example forming an arc away from the plane of the shuttle spine 160.

The suture 70 can have a suture loop 162 at the terminal end of thesuture 70. The suture loop 162 can extend around and completely orpartially circumscribe the suture holder 18. The remainder of the suture70 can be integral with the suture loop 162, or can removably attachedto the suture loop 162. The suture loop 162 can be circular or oval.

FIG. 13b illustrates that the shuttle 14 can have one or more shuttlenotches 166 or cut-outs. For example, the shuttle 14 can have twoshuttle notches 166 on each lateral site of the shuttle. The shuttlenotches 166 can be even longitudinally spaced and distributed along theshuttle 14. The shuttle notches 166 can be curved. The sides of theshuttle 14, other than at the notches, can be straight.

A radius of curvature of the shuttle notch 166 can be from about 1 mm toabout 2 mm.

FIGS. 14a through 14c illustrate that one or both of the longitudinallyterminal ends of the shuttle 14 can be curved or sharpened shuttle tips164. For example, the shuttle tip 164 can have an angled chisel tip orneedle tip.

The shuttle holder can have a holder leader 170 extending away from theshuttle spine 160. The end of the holder leader 170 away from theshuttle spine 160 can be a closed wire loop 98 configured to attach tothe suture 70. A loop neck 172, such as a dual clamp, can fix a firstterminal end of the leader wire to an intermediate point on the holderleader 170, as shown. A second terminal end of the holder leader 170 canextend through the shuttle longitudinal slot 174 and terminate at aleader anchor 168 such as a crimp or swaged ball or disc having a largerdiameter than the width of the shuttle longitudinal slot 174, forexample to slidably attach the suture holder 18 to the shuttlelongitudinal slot 174. The suture holder 18 can be slidably captured inthe shuttle longitudinal slot 174 by the leader anchor 168.

The holder leader 170 can be translatably and/or rotationally fixed inthe shuttle longitudinal slot 174 or can slide and/or rotate in theshuttle longitudinal slot 174. For example, the wire loop 98 can extendpast a first end of the shuttle spine 160 when the shuttle 14 is beingtranslated in a first direction (e.g., toward the lower jaw 80 from theupper jaw 78), and the holder leader 170 can passively rotate andtranslate when the shuttle 14 is then translated in a second direction(e.g., toward the upper jaw 78 from the lower jaw 80).

The holder leader 170 can be rigid or flexible. For example, the holderleader 170 can be made from stainless steel, other material disclosedherein, or combinations thereof.

The suture 70 can be passed through and/or tied to the wire loop 98. Thewire loop 98 can be at a height away from the shuttle spine 160. Thewire loop 98 can extend proximally or distally past the end of theshuttle tip 164. For example, the suture 70 can be attached to the wireloop 98 away from sharp edge sharps to minimize the risk of cutting ordamaging the suture 70.

FIGS. 15a and 15b illustrate that suture 70 can be directly attached orfused to the shuttle spine 160 at a suture attachment 176 in thelongitudinal and lateral middle of the shuttle 14. The suture 70 can bebraided.

For example, the entire shuttle 14 can be made from plastic and can bemolded, overmolded, or otherwise joined to a plastic suture. The suturecan be thermally formed to the shuttle 14. The suture 70 can extendthrough the shuttle 14, for example at a suture anchor 178. The sutureanchor 178 can be the terminal end of the suture 70 extending throughand attached to the shuttle 14.

FIGS. 16a and 16b illustrate that the leader or wire loop 98 can extendpartially or entirely in a plane perpendicular to the plane of theshuttle spine 160. A first terminal end of the wire loop 98 can have aleader first anchor 184. A second terminal end of the wire loop 98 canhave a leader second anchor 186. The shuttle spine 160 can have ashuttle longitudinal first slot 180 and a shuttle longitudinal secondslot 182. The shuttle longitudinal slots 174 can be elongated orcircular. The wire loop 98 can be made from Nitinol and/or steel, forexample, and can be tied to the suture.

The wire loop 98 can extend through the shuttle longitudinal slots 174.The leader first and second anchors can be on the underside (e.g., theconcave side or radially interior side) of the shuttle spine 160. Thewire loop 98 can be on the outerside (e.g., the convex side or radiallyexterior side) of the shuttle spine 160. Neither, one, or both of theleader anchors 168 can be fixed or integrated (e.g., melted or welded)to the shuttle spine 160. Neither, one or both of the leader anchors 168can be slidably attached to the longitudinal slots. The wire loop 98 canbe fixed or slide longitudinally with respect to the shuttle spine 160.

The wire loop 98 can have a longitudinally symmetric or assymetric (asshown) shape. For example, the wire loop 98 can be an arc (similar tothe shape shown by the suture holder 18 in FIGS. 13a and 13b ) or canasymmetrically overhang (as shown) toward one of the ends of thelongitudinal shuttle.

FIG. 17a illustrates that the device 188 can have the shuttle 14 in aposition spanning across the upper jaw 78 and the lower jaw 80. The jawscan have jaw lateral ridges 190. The shuttle fingers 156 can wrap aroundthe jaw lateral ridges 190, for example, slidably attaching the shuttleto the jaws. The jaw lateral ridges 190 at the terminal ends of theupper 78 or top jaw 30 and the bottom or lower jaw 80 can align when thejaws are in a closed configuration, for example so the shuttle 14 canslide along a continuous ridge between the upper 78 and lower jaws 80.

FIG. 17b illustrates that the device 188 can have a lower pusher 76slidably attached to the jaw lateral ridge 190 on the lower jaw 80. Thelower pusher 76 can abut the shuttle 14.

FIG. 17c illustrates that the device 188 can have an upper pusher 86slidably attached to the jaw lateral ridge 190 on the upper jaw 78. Theupper 86 and/or lower pushers 76 can be shaped like the shuttle 14. Theshuttle 14 can be pushed onto a straight length of the lower jaw 80. Theshuttle 14 can deform to a straight configuration when on a straightlength of the jaws and to a curved configuration when on a curved lengthof the jaws.

The pushers can be generally shaped similarly to the shuttles 14, havingfingers, longitudinal slots, spines and lateral slots between thefingers. More than one pusher can be used concurrently on a singledevice 188 (e.g., if the pushers in FIGS. 17b through 17d were shuttles14 and if additional pushers were used), for example to deliver multiplesutures 70 to the same target site.

FIG. 17d illustrates that the shuttle 14 can be pushed, as shown, to theupper jaw 78 by the lower pusher 76. The lower pusher 76 can thenretreat onto the lower jaw 80.

FIGS. 18a and 18b illustrate that the upper and/or lower jaws 80 caneach have jaw spines 208. The jaw spines 208 can extend medially fromthe remainder of the jaws toward (as shown) or away from the jaw controlextension longitudinal axis. For example, the jaws spines can extendfrom the remainder of the jaws distally until the terminal distal ends 2of the jaws, distal to where the jaws extend into a medially-curved jawmedial extension closer to and in the respective jaw tip from a jawlongitudinal extension 191, 202.

The jaws can have jaw lateral ridges 190 or rails 16, as describedelsewhere herein. The jaws can have a T-shaped cross-section.

The shuttle 14 can have shuttle fingers 156 that can each have a shuttledownward extension 196. The shuttle finger 156 can each have a shuttlelateral extensions 192 extending laterally from the respective shuttlespine 160. The shuttle fingers 156 can have shuttle downward extensions196 that can each extend downward (e.g., toward the longitudinal axis ofthe jaw structure) from the laterally terminal ends of the lateralextensions. The shuttle fingers 156 can have shuttle inward extensions194 that can extend inward from the shuttle downward extensions 196. Theshuttle spines 160 and/or lateral extensions, downward extensions, andinward extensions can slidably wrap around the jaw lateral ridges 190.

The upper jaw tip 206 and/or lower jaw tip 198 can have blunt, beveled(e.g., needle-tip), chisel (e.g., beveled on opposite sides, as shown inFIGS. 18a and 18b ), conical, Sprotte, diamond, Tuohy tips, orcombinations thereof (e.g., the upper jaw tip 206 can have a first tipshape and the lower jaw tip 198 can have a second tip shape). The bevelon the distal side of the jaw tips can have the same angle and length,or a smaller angle and longer length than the bevel on the proximal sideof the jaw tips.

The upper jaw tip 206 can have a tip gap 290 or touch the lower jaw tip198 when the jaws are in a closed configuration.

FIGS. 19a and 19b illustrate that the jaw spines 208 in one or both jawscan terminate before the respective jaw tips or jaw medial extensions.

The bevel on the proximal side of the jaw tips can have a smaller angleand longer length than the bevel on the distal side of the jaw tips.

FIGS. 20a and 20b illustrate that the jaw spine 208 on the upper jaw 78can extend along the straight length of the upper jaw 78 and canterminate at or proximal to the upper jaw medial extension 204 or upperjaw tip 206. The jaw lateral ridge 190 on the upper jaw 78 can extend tothe terminal distal tip of the upper jaw 78.

The jaw spine 208 on the lower jaw 80 can extend to the terminal distaltip of the lower jaw 80.

The jaw lateral ridge 190 on the lower jaw 80 can extend along thestraight length of the lower jaw 80 and can terminate at or proximal tothe lower jaw medial extension 200 or lower jaw tip 198.

When the jaws are in a closed configuration, the lower jaw tip 198 canbe positioned proximally to and overlap the upper jaw tip 206. The upperjaw tip 206 and lower jaw tip 198 can overlap along a tip interface 211.For example, the distal end 2 of the jaw spine 208 on the lower jaw 80can overlap and slide against the proximal side of the upper jaw tip206. The upper jaw tip 206 can contact the lower jaw tip 198 at the tipinterface 211 or there can be a gap between the upper jaw tip 206 andthe lower jaw tip 198 at the tip interface 211.

The tip interface 211 can have a tip interface axis 214 with respect tothe jaw structure longitudinal axis 42. The tip interface axis 214 canintersect the jaw structure longitudinal axis 42 at a tip interfaceangle 212 of about 90°.

The upper jaw tip 206 can be distal to the lower jaw tip 198 at the tipinterface 211.

The distal terminal end of the jaw lateral ridge 190 of the upper jaw 78can contact or not contact the distal terminal end of the jaw lateralridge 190 of the lower jaw 80 when the jaws are in a closedconfiguration.

FIGS. 21a and 21b illustrate that the tip interface 211 can have a tipinterface axis 214 with respect to the jaw structure longitudinal axis42. The lower jaw tip 198 can be distal to the upper jaw tip 206 at thetip interface 211. The tip interface angle 212 can be from about 30° toabout 60°, more narrowly 30° to about 45°, for example about 35°.

FIGS. 22a through 22c illustrate that the distal end 2 of the lower jawtip 198 (as shown) or upper jaw tip 206 can have a tip seat 216. The tipseat 216 can be shaped to receive the shape of the opposite jaw tip. Forexample, the tip seat 216 can be triangular (e.g., A-shaped orV-shaped).

The tip seat 216 can surround the lateral sides and distal side of theupper jaw tip 206 when the jaws are in a closed configuration. The tipseat 216 can contact or not contact (i.e., there can be a gap) the upperjaw tip 206 when the jaws are in a closed configuration.

The jaw lateral ridge 190 of the jaw with the tip seat 216 (the bottomjaw 38, as shown) can extend to the terminal end of the lower jaw tip198 and the tip seat 216. The jaw lateral ridge 190 of the jaw oppositeof the tip seat 216 (the upper jaw 78, as shown) can narrow, for to apoint at the terminal end of the respective jaw tip. The narrowed jawlateral ridge 190 can be received within the tip seat 216.

FIGS. 23a and 23b illustrate that the upper 78 and/or lower jaws 80 canhave circular or oval cross-sections. The upper 78 and/or lower jaws 80can be made from solid or hollow rods, for example having a diameter offrom about 0.030 in. to about 0.100 in., for example about 0.060 in.

The terminal end of the upper and/or lower jaw tip 198 can have aconical shape. The terminal end of the lower jaw tip 198 can have an tipseat 216 that can be inverse or negative to a conical shape, for examplesized and shaped to receive the upper jaw tip 206.

The shuttle 14 can have a circular or oval cross-section.

The pushers can have pusher fingers 219 extending from the pusher spine218, similar to the shuttle fingers 156 and shuttle spine 160. Thepusher fingers 219 can be triangular.

FIGS. 24a through 24c illustrate that the distal end 2 of the device 188can be inserted into a cannula 226, for example to be deployedpercutaneously through a cannula 226 inserted in a patient at a targetsite. The cannula 226 can have a cannula inner diameter 228. The cannulainner diameter 228 can be from about 4 mm to about 8 mm, for example 7mm, or 6.86 mm (0.270 in.), or 15 French gauge (5 mm (0.197 in.)).

The shuttle 14 can have a shuttle height 220. The shuttle height 220 canbe from about 0.020 in. to 0.060 in., for example about 0.041 in.

The compression cover 34 can be attached to or integral with one or morejaw control extensions 40. For example the jaw control extensions 40 canextend from the lateral distal ends 2 of the compression cover 34. Thejaw control extension 40 can slidably attach to or contact the jawsdirectly or indirectly. The jaw control extension 40 can push the jawsapart from each other when the jaw control extension 40 is translatedproximally with respect to the jaws, and toward each other when the jawcontrol extension 40 is translated distally with respect to the jaws.

One or more upper cam pins 222 can extend laterally from the one or bothlateral sides of the proximal end of the upper jaw 78. One or more lowercam pins 232 can extend laterally from the one or both lateral sides ofthe proximal end of the lower jaw 80 at the same or differentlongitudinal position as the upper cam pins 222.

The jaw control extensions 40 can have one or more upper cam slots 230and one or more lower cam slots 224. The upper 230 and/or lower camslots 224 can be straight, curved, angled (as shown) or a combinationthereof. The cam pins can be positioned inside and through therespective cam slots. The cam pins can slide within the cam slots.

When the jaw control extension 40 is translated distally with respect tothe jaws, the cam pins can slide proximally within the respective camslots and rotate the jaws away from each other. When the jaw controlextension 40 is translated proximally with respect to the jaws, the campins can slide distally within the cam slots and rotate the jaws towardeach other.

The jaws can have a jaw extension length 234. The jaw extension length234 can be the length from the distal end 2 of the jaw control extension40 to the proximal side of the jaw tips. The jaw extension length 234when the jaws are in a closed configuration can be from about 5 mm toabout 30 mm, for example about 16 mm and 15.95 mm.

The jaws can have a jaw straight gap 236 along the straight length ofthe jaws. The jaw straight gap 236 can be from about 1 mm to about 3.5mm, for example about 1.1 mm or about 3.2 mm. For example, the cannulainner diameter 228 can be 5 mm and the jaw straight gap 236 can be about1.1 mm.

The jaws can be separate or can be integrated at a jaw body. Jawsintegrated in a jaw body can rotatably deform away from each other whenmoved into an open configuration.

FIGS. 25a through 25f illustrate that the upper jaw tip 206 and/or lowerjaw tip 198 can have suture holder slots 238. The suture holder slots238 can extend medially along the outer surface of the respective jawtip. The suture holder slot 238 can extend from the outer surface of thejaw tip to the respective track. The suture holder 18 can be accessiblethrough or extend out of the suture holder slot 238. The suture 70 (notshown) can attach to or be integral with the suture holder 18 in oroutside of the suture holder slot 238.

The upper track 264 can distally terminate at an upper jaw tip shuttleport 240. The lower track 148 can distally terminate at a lower jaw tipshuttle port 256. The shuttle 14 can extend out of or into, and passthrough each of the shuttle 14 ports. During use, the sharpened shuttletip 164 extending out of the shuttle port can pierce, cut and dissecttissue 74 when the jaws are rotated to a closed configuration.

The upper jaw 78 and/or lower jaw 80 can have a jaw stop 242. The jawstop 242 can be a feature, shape or configuration that can abut and stopthe distal translation of the compression cover 34 with respect to thejaws. For example, the distal terminal end of the compression cover 34can abut the jaw stops 242 when the jaws are in a closed configuration.

The radially inner surface of the jaws can have radially inner slopes250.

The upper jaw 78 and/or lower jaw 80 can have a jaw slide 244. The jawslide 244 can be a radially outer surface of the jaws between the jawstops 242 and the compression cover 34 when the compression cover 34 isin a proximally retracted 126 position with respect to the jaws and/orthe jaws are in an opened configuration. The jaw slide 244 can increasein radius from the jaw structure longitudinal axis 42 in the distallongitudinal direction (e.g., the larger the longitudinal dimension ofthe jaw slide 244, the larger the radial dimension of the jaw slide244). When the compression cover is translated distally 138 with respectto the jaws, the radially inner distal edge of the compression cover 34can slide along the jaw slide 244, and press the jaw slide 244 towardthe jaw structure longitudinal axis 42. A radially compressive forcedelivered from the compression cover 34 to the jaw slide 244 can createa torque in the respective jaw, rotating the respective jaw toward thejaw structure longitudinal axis 42 and the opposing jaw.

The device 188 can have a jaw control extension 40. The jaw controlextension 40 can extend along the jaw structure longitudinal axis 42.The jaw control extension 40 can extend between the jaws proximal to thejaw tips. The jaw control extensions 40 can terminate in a jaw controlextension head 254.

The jaw control extension head 254 can have one or two lobes or cams.Each lobe can extend from the longitudinal axis of the jaw controlextension 40 toward a jaw. The lobes can act similarly to the openingroller ball shown in FIGS. 4a, 4d , and elsewhere herein. The upper jaw78 and lower jaw 80 can have upper and inner jaw radially inner slopes250, respectively. The inner slopes can be the radially inner surfacesof the jaws proximal to the jaw tips and distal to the jaw controlextension head 254 when the jaw control extension head 254 is in aproximally retracted position with respect to the jaws. The radiallyinner slope 250 can increase in radius from the jaw structurelongitudinal axis 42 in the distal longitudinal direction (e.g., thelarger the longitudinal dimension of the radially inner slope 250, thelarger the radial dimension of the radially inner slope 250). When thejaw control extension 40 is proximally translated or retracted withrespect to the jaws, the lobes can slide against the radially innerslopes 250 of the jaws and press the jaws away from each other into anopen configuration.

When the jaws are in an open configuration, the compression cover 34 canbe positioned at or proximally past the proximal end of the jaw slides244, and the jaw extension head can be positioned at or proximally pastthe proximal end of the radially inner slopes 250.

The jaw control extension 40 can be attached to or integral with acontrol rail 248. The control rail 248 can extend radially from one orboth lateral sides of the jaw control extension 40, for example in aplane at a right angle to a plane defined by the opposing jaws or theopposing extension head lobes 252.

The compression cover 34 can have a control rail slot 246. The controlrail slot 246 can extend to the distal terminal end of the compressioncover 34. The control rail 248 can be fixed to or longitudinallytranslate within the control rail slot 246. The control rail 248 caninterference fit, abut or stop against the proximal end of the controlrail slot 246, for example when the control rail 248 is in a proximal ordistal longitudinal position with respect to the jaws. The control rail248 can move longitudinally in unison (i.e., coincidentally) with thecompression cover 34 in the distal and/or longitudinal directions. Thecontrol rail 248 can move longitudinally in unison with the jaw controlextension 40 in the distal and/or longitudinal directions.

The device 188 can have an upper socket arm 258 and a lower socket arm270 radially inside of the compression cover 34. The upper socket arm258 and lower socket arm 270 can be a single integrated element (e.g., ahollow cylinder) or separate elements. The upper socket arm 258 can beopposite the lower socket arm 270. The upper socket arm 258 can betranslatably fixed (i.e., mechanically attached to translate in unison)to the lower socket arm 270. The jaw control extension 40 can extendlongitudinally between the upper 258 and lower socket arms 270 or withina hollow channel inside a unitary socket arm (comprising the upper 258and lower socket arms 270 as an integrated element). The distal terminalends of the socket arms can extend to or proximal to the distal terminalend of the compression cover 34 when the jaws are in an openconfiguration.

The proximal terminal end of the upper jaw 78 can have a laterallyelongated upper jaw bearing 262. The upper jaw bearing 262 can extendradially outward from the remainder for the proximal end of the upperjaw 78.

The distal end 2 of the upper socket arm 258 can have a laterallyelongated upper jaw socket 260. The upper jaw socket 260 can openmedially and have a diameter approximately equal to or slightly largerthan the diameter of the upper jaw bearing 262.

An upper jaw 78 hinge can have the upper jaw bearing 262 and the upperjaw socket 260. The upper jaw 78 can rotate around the transverse axisof the upper jaw bearing 262. The upper jaw bearing 262 can rotate inthe upper jaw socket 260.

The proximal terminal end of the lower jaw 80 can have a laterallyelongated lower jaw bearing 266. The lower jaw bearing 266 can extendradially outward from the remainder for the proximal end of the lowerjaw 80.

The distal end 2 of the lower socket arm 270 can have a laterallyelongated lower jaw socket 268. The lower jaw socket 268 can openmedially and have a diameter approximately equal to or slightly largerthan the diameter of the lower jaw bearing 266.

A lower jaw 80 hinge can have the lower jaw bearing 266 and the lowerjaw socket 268. The lower jaw 80 can rotate around the transverse axisof the lower jaw bearing 266. The lower jaw bearing 266 can rotate inthe lower jaw socket 268.

The upper 86 and/or lower pushers 76 can have entire lengths or onlydistal ends 2 that can have articulated segmentations 286. Thearticulated segments 286 can rotate with respect to each other around anaxis perpendicular to the longitudinal axis of the respective pusher.The articulated segmentations 286 can be connected by a discrete hinge(e.g., a pin or snap connection) or can be longitudinally coincidentalor longitudinally alternating lateral slots cut into the sides of thepusher, similar to the shape of the shuttle lateral slots 158. Theproximal end of either or both upper 86 and lower pushers 76 can have acontinuous, non-segmented, flat, uniform ribbon of material.

Each of the upper 86 and/or lower pushers 76 can have distal terminalends that can have a shuttle seat 274. The shuttle seat 274 can be aninverse shape to the shape of the shuttle tip 164. For example, if theshuttle tip 164 has an angled end, the shuttle seat 274 can have theopposite angle. If the shuttle tip 164 has a convex curved end, theshuttle seat 274 can have a concave curved end with the same radius ofcurvature as the shuttle tip 164.

FIGS. 26a through 26d illustrate that the compression cover 34 can bedistally translated, as shown by arrow, with respect to the jaws. Thecompression cover 34 can deliver translational force through the edgesof the control rail slot 246 to the control rail 248. The control rail248 can deliver the translational force to the jaw control extension 40.The jaw control extension 40 can translate distally, as shown by arrow,concurrently with the compression cover 34. The compression cover 34 cantranslate 138 over the jaw slides 244, pressing radially inward on thejaw slides 244. The jaw control extension head 254 can move distallywith respect to the jaws, as shown by arrow 280, for example, allowingthe closure of the jaws without interference fitting or abutting againstthe jaw control extension head 254. The upper jaw 78 and/or lower jaw 80can rotate radially inward, as shown by arrows.

When the jaws are in a closed configuration, the compression cover 34can be positioned at or adjacent to the jaw stop 242, and the jawextension head can be positioned at or proximally past the proximal endof the radially inner slopes 250.

When the jaws are in a closed configuration, if the shuttle 14 is in theupper track 264, the upper pusher 86 can translate distally through theupper track 264. The distal terminal end of the upper pusher 86 can abutthe shuttle 14. The upper pusher 86 can then push the shuttle 14 throughthe upper track 264, out the upper jaw tip shuttle port 240 and into thelower jaw tip shuttle port 256.

When the jaws are in a closed configuration, if the shuttle 14 is in thelower track 148, the lower pusher 76 can translate distally through thelower track 148. The distal terminal end of the lower pusher 76 can abutthe shuttle 14. The lower pusher 76 can then push the shuttle 14 throughthe lower track 148, out the lower jaw tip shuttle port 256 and into theupper jaw tip shuttle port 240.

When the shuttle 14 is pushed from the upper track 264 to the lowertrack 148 or vice versa, the shuttle 14 can be curvilinearly translated282, as shown by arrow, following the paths of the upper track 264 andthe lower track 148.

When the jaws are in a closed configuration, the shuttle 14 can movefrom the upper jaw 78 to the lower jaw 80, as shown by arrow, back tothe upper jaw 78, and can repeat the motion from the upper jaw 78 to thelower jaw 80, and optionally from the lower jaw 80 to the upper jaw 78one, two or more times.

The device 188 can have a pusher lockout that can prevent translation ofthe pushers and the shuttle 14 when the jaws are in an openconfiguration.

The device 188 can have a jaw lockout preventing opening of the jawswhen either of the pushers is extended out of the respective jaw tipshuttle port and/or when the shuttle 14 is concurrently in the upper jaw78 and the lower jaw 80.

FIG. 27 illustrates that the upper pusher 86 can be distally translatedwith respect to the jaws. The upper pusher 86 can curvilinearlytranslate, as shown by arrows 284 and 288, along the upper track 264.The distal terminal end of the upper pusher 86 can exit out of andextend from the upper jaw tip shuttle port 240. The V-shaped (orA-shaped), or curved (e.g., U-shaped) shuttle seat 274 at the distalterminal end of the upper pusher 86 can abut the V-shaped (or A-shaped),or curved (e.g., U-shaped) shuttle tip 164 at the terminal end of theshuttle. The upper pusher 86 can push the shuttle 14 through the uppertrack 264, across the gap between the upper jaw tip shuttle port 240 andthe lower jaw tip shuttle port 256, and into the lower track 148. Theshuttle 14 can have a curvilinear translation 282, as shown by arrow,along the tracks.

The lower pusher 76 can have no or one lower pusher articulating segment(as shown), or can have a number of articulating segments, similar tothe upper pusher 86 in FIG. 27.

FIG. 28 illustrates that the suture 70 can be tied or adhered directlyto suture holder 18, for example as shown in FIGS. 13a and 13b . Thesuture 70 can have a suture loop 162. The suture loop 162 cancircumscribe the suture holder 18.

FIG. 29 illustrates that when the jaws are in a closed configuration,the terminal end of the upper jaw tip 206 can be in contact with or havea tip gap 290 to the terminal end of the lower tip jaw. The tip gap 290can be from about 0 in. to about 0.020 in., for example about 0.008 in.

The shuttle 14 can have a shuttle width 292. The shuttle width 292 canbe from about 0.030 in. to about 0.100 in., for example about 0.060 in,or, as another example, about 0.055 in. As another example, the shuttlewidth 292 can be about 0.053 in. to about 0.057 in., or more broadly,from about 0.35 in. to about 0.075 in., including every 0.001 in.increment within these ranges (e.g., 0.055 in.).

The shuttle 14 can be made from nickel titanium alloys (e.g., Nitinol),stainless steel, other materials disclosed herein, or combinationsthereof.

FIGS. 30a, 30b and 31 illustrate that the lever 106 or handle 104 cancontrol the rotation, and opening and closing of the jaws.

The handle 104 can have a handle pivot 302. The handle pivot 302 can bea rotatable pin joint where the handle 104 can rotatably attach to thebase 102. The handle 104 can rotate around the handle pivot 302 withrespect to the base 102.

The handle 104 can be attached to the socket arms and/or the compressioncover 34 (as shown). For example, the compression cover 34 can haveradially and/or laterally extending cover pins 304. The cover pins 304can attach to the jaw control extension 40. The handle 104 can have oneor two transmission ports 314 or loops 296 on opposing lateral sides ofthe compression cover 34. The cover pins 304 can extend through thetransmission loops 296.

The other of the socket arms (as shown) and compression cover 34 notattached to the handle 104 can be attached to the base 102.

Squeezing and rotating the handle 104 toward the base 102 can distallyextend 138 the compression cover 34 and jaw control extension 40 withrespect to the jaws, or proximally retract 126 the jaws with respect tothe compression cover 34 and jaw control extension 40. When the handle104 is rotated, the jaws can move to an open configuration. For example,when the bottom of the handle 104 is rotated proximally toward the base102, the transmission loop 296 can rotate distally toward the jaws,pushing the cover pin 304 and the compression cover 34 distally. Thetransmission loop 296 can force the compression cover 34 and/or jawcontrol extension 40 to translate distally, for example, closing thejaws.

The proximal end of the upper socket arm 258 and the proximal end of thelower socket arm 270 can be an integral element or can be fixedlyattached by a socket arm brace 300.

The terminal proximal end of the upper pusher 86 can attach to or beintegrated with an upper pusher 86 shaft and/or upper pusher button 210a. The terminal proximal end of the lower pusher 76 can attach to or beintegrated with a lower pusher shaft and/or lower pusher button 210 b.The proximal distal ends 2 of the upper pusher button 210 a and lowerpusher button 210 b can be above and below each other or side-by-side(e.g., left and right, as shown). The device 188 can be configured sothat pressing (e.g., distally translating) the upper pusher button 210 acan distally advance the upper pusher 86, and pressing (e.g., distallytranslating) the lower pusher button 210 b can distally advance theupper pusher 86. Pressing the upper pusher button 210 can proximallyretract the lower pusher 76 and/or lower pusher button 210 b. Pressingthe lower pusher button 210 b can proximally retract the upper pusher 86and/or upper pusher button 210.

The medial sides of the distal ends 2 of the upper and lower pusherbuttons 210 b can have upper pusher button gears 310 and lower pusherbutton gears 306, respectively. The upper pusher button gears 310 canface the lower pusher button gears 306.

The pusher toggle knob 294 can be rotatably attached to the base 102.The pusher toggle knob 294 can be integrated or rotationally fixed to apusher toggle knob gear 308. The pusher toggle knob gear 308 canrotatably interface and interdigitate with the upper pusher button gear310 on a first side and with the lower pusher button gear 306 on theopposite side of the upper pusher button gear 310.

When the upper pusher button translates distally 284, the upper pusherbutton gear 310 can rotate the pusher toggle gear, for example alsorotating the top of the pusher toggle knob 294 to a position indicatingthat the upper pusher button 210 a has been translated distally 284. Thetop surface or circumference of the top of the pusher toggle knob 294can have an indicator, such as an arrow, that can indicate whether theupper pusher 86 or the lower pusher 76 has been translated and by howfar, for example indicating the position of the shuttle 14 in the uppertrack 264, lower track 148, extending out of one track, or extendingacross both tracks simultaneously. The pusher toggle gear cansimultaneously proximally translate the lower pusher button gear 306.For example, when the upper pusher 86 is distally translated, the lowerpusher 76 can be simultaneously proximally translated at the same speed.

When the lower pusher button 210 b translates distally, the lower pusherbutton gear 306 can rotate the pusher toggle gear, for example alsorotating the top of the pusher toggle knob 294 to a position indicatingthat the upper pusher button 210 a has been translated distally 284. Thepusher toggle gear can simultaneously proximally translate the upperpusher button gear 310. For example, when the lower pusher 76 isdistally translated, the upper pusher 86 can be simultaneouslyproximally translated at the same speed.

The pusher toggle knob 294 can be rotated to translate the upper pusher86 and the lower pusher 76 by transmitting the torque applied to pushertoggle knob 294 through the pusher toggle knob gear 308 and to the upperpusher button gear 310 and/or lower pusher button gear 306 with orwithout pressing on the proximal terminal ends of the pusher buttons.

FIGS. 32a and 32b illustrates that the pusher toggle knob 294 can berotated to translate the upper pusher 86 and the lower pusher 76 bytransmitting the torque applied to pusher toggle knob 294 through thepusher toggle knob gear 308 and to the upper pusher button gear 310and/or lower pusher button gear 306 with or without pressing on theproximal terminal ends of the pusher buttons.

The diameter of the pusher toggle knob 294 can be smaller than the widthof the base 102, as shown in FIGS. 30a, 30b and 31, or larger than thewidth and height of the base 102, and the same size or larger than thehandle 104, and the compression cover 34, as shown in FIGS. 32a and 32b.

In a variation of a method of use, the distal end 2 of the device 188including the jaws can be inserted through a percutaneous cannula 226when the jaws are in a closed configuration. When the distal end 2 ofthe device 188 exits the distal end 2 of the cannula 226 at the targetsite, the handle 104 can be released to rotate away from the base 102.The handle rotation away from the base 102 can move the jaws to an openconfiguration. The distal end 2 of the device 188 can then be furtherpositioned so the target site is between the upper jaw distal tip 206and the lower jaw distal tip 198. The handle 104 can then be squeezed torotate the handle 104 toward the base 102. The handle rotation towardthe base 102 can move the jaws into a closed configuration, pinchingtogether tissue 74 at the target site. The shuttle 14 can be completelyrecessed in the jaw into which the shuttle 14 is loaded, or the shuttletip 164 can extend out of whichever jaw the shuttle is currently loadedinto. The shuttle tip 164 can pierce the tissue 74 as the jaws areclosed or after the jaws are closed when the shuttle 14 is translated.

After the jaws are closed, the upper 210 a or lower pusher button 210 b(e.g., respective to whichever track the shuttle 14 is currently in) canbe pressed, distally advancing the respective pusher. The respectivepusher can press the shuttle 14 distally, through the gap between theupper 78 and lower jaws 80, if such a gap exists, or directly from onejaw to the other jaw. The shuttle 14 can pull the suture 70 to followthe path of the shuttle 14 or follow a path adjacent to the shuttle 14.When the respective pusher button is fully depressed, the device 188 canemit a sound and/or tactile response (e.g., from a snap or detent in thebutton or pusher and track) and the pusher toggle knob 294 can have anindicator (e.g., a line or arrow) indicating that the shuttle 14 hasbeen fully translated across the jaws.

The handle 104 can then be rotated away from the base 102. For example,the handle 104 can be released and spring loaded to return to a positionrotated away from the base 102. The rotating handle can proximallytranslate the transmission loop 296. The transmission loop 296 canproximally pull and translate the compression cover 34 and jaw controlextension 40, opening the jaws.

The device 188 can then be repositioned so the jaw tips are removedentirely, for example if stitching is complete, or moved adjacent totheir previous position in order to place a new stitch. The handle 104can then be squeezed, closing the jaws. The pusher button of the trackin which the shuttle 14 is positioned can then be pressed. The shuttle14 can then move to the opposite jaw, as described above, pulling thesuture 70 through the tissue 74 and forming a stitch.

The above method can be repeated as needed to create a length andposition of desired stitches.

Any or all elements of the device 188 and/or other devices 188 orapparatuses described herein can be made from, for example, a single ormultiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol),cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin,Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.),nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial TradingCompany, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZMalloy, for example), tungsten-rhenium alloys, polymers such aspolyethylene teraphathalate (PET)/polyester (e.g., DACRON® from E. I. DuPont de Nemours and Company, Wilmington, Del.), polypropylene, (PET),polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone(PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK)(also poly aryl ether ketone ketone), nylon, polyether-blockco-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France),aliphatic polyether polyurethanes (e.g., TECOFLEX® from ThermedicsPolymer Products, Wilmington, Mass.), polyvinyl chloride (PVC),polyurethane, thermoplastic, fluorinated ethylene propylene (FEP),absorbable or resorbable polymers such as polyglycolic acid (PGA),polylactic acid (PLA), polycaprolactone (PCL), polyethyl acrylate (PEA),polydioxanone (PDS), and pseudo-polyamine tyrosine-based acids, extrudedcollagen, silicone, zinc, echogenic, radioactive, radiopaque materials,a biomaterial (e.g., cadaver tissue 74, collagen, allograft, autograft,xenograft, bone cement, morselized bone, osteogenic powder, beads ofbone) any of the other materials listed herein or combinations thereof.Examples of radiopaque materials are barium sulfate, zinc oxide,titanium, stainless steel, nickel-titanium alloys, tantalum and gold.

The shuttle 14 throughout the disclosure herein can be attached to asuture 70. Accordingly, the suture 70 can be attached to the shuttle 14and can follow the movement of the shuttle 14. Similarly, the suture 70can be attached to and detached from the shuttle 14, for example,attached before and detached after the desired stitching or suturing iscomplete.

The shuttle 14 can be translatable (e.g., slideable) in the jawstructure 28, for example, in the jaw tracks (e.g., jaw tracks 66 and64). The shuttle can be configured to translate (e.g., slide) in the jawstructure 28, for example, the jaw tracks (e.g., jaw tracks 66 and 64).

FIG. 33A illustrates that the suture holder 18 can be attached to orintegrated with the shuttle 14. For example, the suture holder 18 can bea bridge integrated with the shuttle spine 160. A portion of the shuttlespine 160 can define the suture holder 18. As another example, thesuture holder 18 can be removably attached to the shuttle 14. The sutureholder 18 can extend between a shuttle first lateral side and a shuttlesecond lateral side. The suture holder 18 can extend between a shuttlefirst longitudinal side and a shuttle second longitudinal side. Thesuture holder 18 can be in the longitudinal center of the shuttle 14, ona proximal end of the shuttle 14, or on a distal end of the shuttle 14.A center of the suture holder 18 can be in the transverse center of theshuttle 14, on a first lateral side of the shuttle, or on a secondlateral side of the shuttle. The suture holder 18 can be in the plane ofthe shuttle spine 160, extend away from the plane of the shuttle spine160, or both. For example, FIG. 33A illustrates that the suture holder18 does not extend away from the plane of the shuttle spine 160. Theplane of the suture holder 18 can be flush with or coincident with theplane of the shuttle spine 160. This can advantageously allow theshuttle and suture holder 14, 18 to take up less space, therebyminimizing the trauma to surrounding tissue as the shuttle 14 is passedbetween the upper and lower jaws 30, 38 since it brings the base of thesuture 70 closer to the shuttle 14. With the suture 70 closer to theshuttle 14, the force of the suture 70 against surrounding tissue isreduced as compared to when the suture 70 is connected to a structureout of the plane of the shuttle spine 160 (e.g., the suture holder 18 ofFIGS. 13a and 13b ). The shuttle and suture holder 18 can be amonolithic structure. The suture loop 162 can extend around andcompletely or partially circumscribe the suture holder 18. The remainderof the suture 70 can be integral with the suture loop 162, or canremovably attached to the suture loop 162. The suture loop 162 can beattached to or integrated with the suture 70 at a suture junction 73.The suture junction 73 can be a knot, a braid, or both. The suture loop162 can be circular, oval, or stadium-shaped.

The shuttle 14 can have zero, one, or multiple suture holes 404, forexample, 0 to 4 or more suture holes 404, including every 1 suture holeincrement within this range. For example, FIG. 33A illustrates that theshuttle 14 can have a first suture hole 404 a and a second suture hole404 b. The shuttle holes 404 (e.g., first and second suture holes 404 a,404 b) can have a regular or irregular shape, for example, curved,polygonal, or both. The suture holes 404 can be defined by one or morecurved surfaces or curved edges, for example, one or more curvedsurfaces or curved edges of the shuttle 14. The suture holes 404 can bedefined by one or more flat surfaces or straight edges, for example, oneor more flat surfaces or straight edges of the shuttle 14. The sutureholes 404 can have a cross-sectional shape of a circle, ellipse,rectangle, stadium, horseshoe, star, slot, or any combination thereof.The suture holes 404 can have such cross sectional shapes when theshuttle is curved or flat. The suture holes 404 can have a constantcross-sectional area or a tapered cross-sectional area.

The shuttle tips 164 can be beveled, non-beveled, or both. For example,FIG. 33A illustrates that the shuttle tips 164 can be non-beveled. Theshuttle tips 164 can have one or multiple tip surfaces 406, for example,1 to 4 or more tip surfaces 406, including every 1 tip surface incrementwithin this range (e.g., 1 tip surface, 2 tip surfaces). For example,FIG. 33A illustrates that the shuttle tips 164 can have a first tipsurface 406 a (e.g., a first non-beveled tip surface as shown in FIG.33A) and a second tip surface 406 b (e.g., a second non-beveled tipsurface as shown in FIG. 33A). The non-beveled portion of the shuttletips 164 can advantageously improve the force transfer from the upperand lower pushers 86, 76, thereby making it easier for the pushers 86and 76 to push against the shuttle 14. A larger component of the forcefrom the pushers (e.g., pushers 86 and 76) can be transferred along thelongitudinal axis of the shuttle 14 when the shuttle tip 164 has anon-beveled surface 406 as compared to a beveled surface (e.g., thebeveled surfaces shown in FIGS. 14a-14c ). For beveled surfaces, aportion of the force applied to the shuttle 14 is directed against thesurfaces that define the lower and upper tracks 66, 64 perpendicularlyaway from the beveled surface. When a pusher applies a longitudinalforce against a beveled surface, a portion of the longitudinal forceapplied to the shuttle 14 by the pusher is transformed into a transversecomponent away from the longitudinal axis of the shuttle 14.

FIG. 33A further illustrates that the shuttle tips 164 can be tapered toform a terminal tip 165. The terminal tip 165 can be an edge or part ofa rounded or flat surface. The tapered portion of the shuttle tip 164can be a first bevel, for example, a first transverse bevel toward alongitudinal axis (e.g., center longitudinal axis) of the shuttle 14.The non-beveled surfaces 406 can thereby form first tissue cuttingsurfaces that are beveled in a first direction. The bevel referred to inthe preceding paragraph can refer to a second bevel, for example, asecond transverse bevel angled relative to a transverse axisperpendicular to the transverse axis of the first bevel and toward alongitudinal axis (e.g., center longitudinal axis) of the shuttle 14.Such a second bevel is shown in FIGS. 14a-14c . The second bevels candefine second beveled surfaces along the taper that face a seconddirection different from the first direction. The second bevels can formsecond tissue cutting surfaces. The shuttle tips 164 can pierce or cuttissue. The tapered portion of the shuttle tips 164 can pierce or cuttissue. The tip surfaces 406 (e.g., tip surfaces 406 a and 406 b) canpierce or cut tissue. When the shuttle tips 164 have first and secondbevels, the first and second bevels can pierce tissue or cut tissue.FIG. 33A illustrates that the shuttle tips 164 can be non-sharpened,meaning that while the edges are tapered to form a first cuttingsurface, the cutting surfaces 406 themselves can be chamfered ornon-chamfered. The shuttle tips 164 can be non-sharpened and still cutor pierce tissue, where sharpened or non-sharpened can refer to thepresence or non-presence of a second bevel (e.g., as shown in FIGS.14a-14c ), respectively.

FIG. 33A further illustrates that the device 188 can have one ormultiple male stops 412 (also referred to as male catches, male detents,stops, catchers, detents) and one or multiple female stops 416 (alsoreferred to as female catches, female detents, stops, catchers,detents). The device 188 can have, for example, 1-10 or more male stops412, including every 1 male stop increment within this range (e.g., 1,2, 3, 4 or more male stops). The device 188 can have, for example, 1-10or more female stops 416, including every 1 female stop increment withinthis range (e.g., 1, 2, 3, 4 or more female stops).

The male stops 412 can be attached to or integrated with the device 188.For example, the male stops 412 can be part of, attached to, orintegrated with the shuttle 14. As another example, the male stops 412can be part of, attached to, or integrated with the jaws (e.g., jaws 30,38, 78, 80). As yet another example, the device 188 can have some malestops 412 that are part of, attached to, or integrated with the shuttle14 and can have some male stops 412 that are part of, attached to, orintegrated with the jaws (e.g., jaws 330, 38, 78, 80). As yet stillanother example, the male stops 412 can be part of, attached to, orintegrated with the pushers (e.g., the lower and upper pushers 76, 86).

The female stops 416 can be attached to or integrated with the device188. For example, the female stops 416 can be part of, attached to, orintegrated with the shuttle 14. As another example, the female stops 416can be part of, attached to, or integrated with the jaws (e.g., jaws330, 38, 78, 80). As yet another example, the device 188 can have somefemale stops 416 that are part of, attached to, or integrated with theshuttle 14 and can have some female stops 416 that are part of, attachedto, or integrated with the jaws (e.g., jaws 330, 38, 78, 80). As yetstill another example, the female stops 416 can be part of, attached to,or integrated with the pushers (e.g., the lower and upper pushers 76,86).

FIGS. 33A-34B illustrate, for example, that the shuttle 14 can have themale stops 412 and that the jaws (e.g., jaws 330, 38, 78, 80) can havethe female stops 416. For example, FIGS. 33A-34B illustrate that theshuttle 14 can have a first male stop 412 a and a second male stop 412b, that the lower jaw (e.g., jaw 38, 80) can have a first female stop416 a (also referred to as the lower jaw first female stop 416 a andother similar terms) configured to releasably engage with or releasablyattach to the first male stop 412 a, and that the upper jaw (e.g., jaw30, jaw 78) can have a second female stop 416 b (also referred to as theupper jaw first female stop 416 b and other similar terms) configured toreleasably engage with or releasably attach to the second male stop 412b. Half of the lower and upper jaws are shown transparent in FIGS.33A-34B so that the shuttle 14 can be more easily seen in the jaw tracks(e.g., lower and upper tracks 66, 64), and so that the male and femalestops 412, 416 can be more easily seen.

Each male stop 412 can releasably fit into, attach to, or engage with acorresponding female stop 416, for example, via a friction fit, snapfit, magnetic fit, ratchet fit, or any combination thereof. For example,the first male stop 412 a can be configured to releasably attach to thefirst female stop 416 a and the second male stop 412 b can be configuredto releasably attach to the second female stop 416 b. When two stops(e.g., male and female stops 412, 416) are releasably attached to oneanother, a threshold release force can be required to release the stopsfrom one another. The threshold release force can be from about 1.0Newton to about 10.0 Newtons or more, including every 0.5 Newtonincrement within this range (e.g., 4.0 Newtons, 4.5 Newtons, 5.0Newtons). As another example, the release force can be from about 0.5lbs to about 1.5 lbs, including every 0.1 lb increment within this range(e.g., 1.0 lb).

The male stops 412 can be a positive feature such as a protrusion, bump,ridge, arm, extension, flexure, detent flexure, or any combinationthereof. The male stops 412 can be straight and/or curved. The malestops 412 can be flexible, rigid, or both (e.g., a first portion can beflexible and a second portion can be rigid). The male stops 412 can beone or more springs. The female stops 416 can be a negative feature suchas a void, space, pocket, notch, hole, through hole, recess, detentrecess, or any combination thereof. The female stops 416 can beflexible, rigid, or both (e.g., a first portion can be flexible and asecond portion can be rigid). The male and female stops 412, 416 caninclude magnets that attract one another to keep the male and femalestops releasably attached together.

The male stops 412 can have a male surface 414 and the female stops 416can have a female surface 418. The male and female surfaces 414, 418 canbe configured to engage with one another, slidably engage with oneanother, contact one another other, or any combination thereof. Thefemale stops 416 can have a lip 420 configured to engage with, slidablyengage with, or contact the male stop 412, or any combination thereof.The male stops 412 can be configured to engage with, slidably engagewith, or contact the lip 420, or any combination thereof.

For each male-female stop pair, the male and female surfaces 414,418 canengage with one another and/or the male stop 412 can engage with the lip420, for example, when the male stop 412 is being forced into the femalestop 416, when the male stop 412 is being withdrawn from the female stop416, when the female stop 416 is being forced over or onto the male stop412, when the female stop 416 is being withdrawn from the male stop 412,when the male and female stops 412, 416 are attached to one another(also referred to as the stopped position, caught position, fixedposition), or any combination thereof. As another example, two femalestops 416 can engage with one another, for example, where the two femalestops 416 include a magnet. As yet another example, two male stops 412can engage with one another, for example, where the two male stopsinclude a magnet. The male and/or female stops 412, 416 can form a hookor hook-like feature to releasably catch the other stop.

The male stops 412 can move relative to the female stops 416, viceversa, or both. The female stops 416 can move relative to the male stops412, vice versa, or both. For example, FIG. 33A illustrates that themale stops 412 can be translatable (e.g., slidably translatable) in thelower jaw track, for example, in a first direction toward the firstfemale stop 416 a and in a second direction away from the first femalestop 416 a, or vice versa such that the first female stop 416 a istranslatable toward and away from a male stops 412 (e.g., forarrangements where the female stop 416 is integrated with or attached tothe shuttle 14 and the male stop 412 is integrated with or attached tothe lower jaw). As another example, FIG. 34A illustrates that the malestops 412 can be translatable (e.g., slidably translatable) in the upperjaw track, for example, in a first direction toward the second femalestop 416 b and in a second direction away from the second female stop416 b, or vice versa such that the second female stop 416 b istranslatable toward and away from a male stop 412 (e.g., forarrangements where the female stop 416 is integrated with or attached tothe shuttle 14 and the male stop 412 is integrated with or attached tothe upper jaw). The first and second directions can be opposite from oneanother.

FIGS. 33A and 33B illustrate that when the shuttle 14 is beingtranslated (e.g., pushed by the upper jaw pusher 86, pulled by the lowerjaw pusher 76, or both) in a first direction in the lower jaw tracktoward the first female stop 416 a, the lip 420 can exert a forceagainst the first male stop 412 a that causes the first male stop 412 ato flex toward a longitudinal axis of the shuttle 14. This flexure canallow the first male stop 412 a to fit into the first female stop 416 a.Upon passing by the lip 420, the first male stop 412 a can rebound toits neutral position or to a less flexed position and releasably lockthe shuttle 14 to the lower jaw via the releasable attachment betweenthe first male stop 412 a and the first female stop 416 a. FIGS. 33A and33B further illustrate that when the shuttle 14 is being translated(e.g., pulled by the upper jaw pusher 86, pushed by the lower jaw pusher76, or both) in a second direction (e.g., opposite the first direction)in the lower jaw track away from the first female stop 416 a, the femalesurface 418 can exert a force against the first male stop 412 a thatcauses the first male stop 412 a to flex toward a longitudinal axis ofthe shuttle 14. This flexure can allow the first male stop 412 a toslide under and past the lip 420. Upon passing by the lip 420 in thesecond direction, the first male stop 412 a can rebound to its neutralposition (also referred to as a non-flexed position). When the firstmale stop 412 a flexes, it can deflect into the first suture hole 404 a.

FIGS. 34A and 34B illustrate that when the shuttle 14 is beingtranslated (e.g., pushed by the lower jaw pusher 76, pulled by the upperjaw pusher 76, or both) in a first direction in the upper jaw tracktoward the second female stop 416 b, the lip 420 can exert a forceagainst the second male stop 412 b that causes the second male stop 412b to flex toward a longitudinal axis of the shuttle 14. This flexure canallow the second male stop 412 b to fit into the second female stop 416b. Upon passing by the lip 420, the second male stop 412 b can reboundto its neutral position or to a less flexed position and releasably lockthe shuttle 14 to the upper jaw via the releasable attachment betweenthe second male stop 412 b and the second female stop 416 b. FIGS. 34Aand 34B further illustrate that when the shuttle 14 is being translated(e.g., pushed by the upper jaw pusher 86, pulled by the lower jaw pusher76, or both) in a second direction (e.g., opposite the first direction)in the upper jaw track away from the second female stop 416 b, thefemale surface 418 can exert a force against the second male stop 412 bthat causes the second male stop 412 b to flex toward a longitudinalaxis of the shuttle 14. This flexure can allow the second male stop 412b to slide under and past the lip 420. Upon passing by the lip 420 inthe second direction, the second male stop 412 b can rebound to itsneutral position (also referred to as a non-flexed position). When thefirst male stop 412 a flexes, it can deflect into the second suture hole404 b.

The lip 420 can resist passage of the first and second male stops 412 a,412 b along the second direction out of the first and second femalestops 416 a, 416 b with the threshold release force. The female surface418 can be an inner surface of the lip 420. The lip 420 can resistpassage of the first and second male stops 412 a, 412 b along the firstdirection into the first and second female stops 416 a, 416 b with thethreshold release force or a lesser force (e.g., a force 10% to 75% ofthe threshold release force).

The device 188 can have zero, one, or multiple male stops 412 and zero,one, or multiple female stops 416 on the device distal end 2 (e.g.,closer to the jaws than to the handle 104) and/or on the device proximalend (e.g., closer to the handle 104 than to the jaws). For example, theupper jaw (e.g., upper jaw 78) can have one or multiple male stops 412,one or multiple female stops 416, or any combination thereof. The lowerjaw (e.g., lower jaw 80) can have one or multiple male stops 412, one ormultiple female stops 416, or any combination thereof. The male and/orfemale stops 412 and/or 416 can be attached to or integrated with thejaw, the jaw track, or both. The shuttle 14 can have one or multiplemale stops 412, one or multiple female stops 416, or any combinationthereof. The male stops 412 can extend away from and/or toward alongitudinal axis of the shuttle 14. The male stops 412 can extend awayfrom and/or toward a longitudinal axis of a jaw track (e.g., tracks 66and 64). The female stops 416 can extend away from and/or toward alongitudinal axis of the shuttle 14. The female stops 416 can extendaway from and/or toward a longitudinal axis of a jaw track (e.g., tracks66 and 64).

For example, FIG. 33A illustrates that the shuttle 14 can have a firstmale stop 412 a and a second male stop 412 b, and that the lower andupper jaw tracks (e.g., tracks 66 and 64) can each define a female stop416 (e.g., a first female stop 416 a in the lower jaw and a secondfemale stop 416 b in the upper jaw). The lower and upper jaws can eachdefine one or multiple female stops 416. For example, the first malestop 412 a can releasably attach to the first female stop 416 a and thesecond male stop 412 b can releasably attach to a second female stop 416b. FIG. 33A illustrates that the first and second male stops 412 a, 412b can extend away from a longitudinal axis (e.g., center longitudinalaxis) of the shuttle toward a longitudinal center of the shuttle 14. Thefirst and second male stops 412 a, 412 b can be the same or a differentdimension away from the longitudinal center of the shuttle 14 as theother detent.

FIGS. 33A-34B further illustrate a surface 422 of jaw suture slots 238,for example, lower jaw suture slot 238 a and upper jaw suture slot 238b.

FIGS. 33B and 34B illustrate that the shuttle tips 164 can have ashuttle tip thickness 408 of about 0.05 mm to about 0.75 mm, includingevery 0.05 mm increment within this range (e.g., 0.15 mm, 0.20 mm, 0.25mm). The shuttle tip thickness 408 can be the width of the non-beveledsurfaces 406. As another example, the shuttle tip thickness 408 can befrom about 0.0080 in. to about 0.0090 in. (e.g., 0.0085 in.).

FIGS. 33B and 34B further illustrate that the shuttle 14 can have ashuttle thickness 410 (also referred to as the shuttle thickness 14_(T)) of about 0.05 mm to about 0.75 mm, including every 0.05 mmincrement within this range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). Theshuttle tip thickness 408 can be the same or different from the shuttlethickness 410. The shuttle tip thickness 408 can be less than, equal to,or greater than the shuttle thickness 410. For example, the shuttle tipthickness 408 can be about 0.15 mm and the shuttle thickness 410 can beabout 0.25 mm, or vice versa.

The shuttle 14 can be made from a single panel of material (e.g.,metal). The suture holes 404 can be cut, leaving the shuttle 14 and themale stops 412. The shuttle 14 can then be bent, which can result in themale stops 412 extending out of the plane of the shuttle spine 160.

FIGS. 33A-34B further illustrate that a portion 423 of the shuttle tips164 can remain exposed outside of the jaws when the shuttle 14 is fullytranslated into the jaws. The exposed portion 423 can have an exposedlength 424, for example, from about 0.25 mm to about 5.00 mm or more,including every 0.25 mm increment within this range (e.g., 0.50 mm, 1.00mm, 1.50 mm). The exposed portion 423 can align the lower and upper jawswhen they close. The exposed portion 423 can pierce tissue when thelower and upper jaws are closed against each other and before theshuttle 14 is translated to the other jaw. This can advantageouslyleverage the clamping force of the jaws to cut tissue with the shuttle14. A portion of the exposed portion 423 can pierce tissue when theshuttle 14 is translated from the lower jaw to the upper jaw, or viceversa.

FIG. 35 illustrates that all or a portion of the exposed portion 423 canbe in the other jaw when the lower and upper jaws are closed and beforethe shuttle 14 is translated to the other jaw via the lower or upperpusher 76, 86. For example, when the jaws are moved from an openconfiguration to a closed configuration with the exposed portion 423extending from the upper jaw (e.g., jaw 30, jaw 78) as shown in FIGS.33A and 33B, the exposed portion 423 can be moved into the lower jaw(e.g., jaw 38, jaw 80) via the jaws closing with or without translation(e.g., simultaneous translation) of the shuttle 14 into the lower jawvia an upper and/or lower pusher while the jaws are being closed.

FIG. 35 further illustrates that the female stops 416 can have an outersurface 419 and an inner surface 418 (also referred to as a femalesurface). The outer surface 419 can be flat or curved. The outer surface419 can define a ramp surface for the male stops 412 to flex against.The outer surface 419 can define a plane at an angle to a longitudinalaxis of the shuttle. For example, the plane of the outer surface 419 canbe perpendicular or substantially perpendicular to the centerlongitudinal axis of the shuttle. The inner surface can be flat orcurved. The inner surface 418 can define a ramp surface for the malestops 412 to flex against.

FIG. 35 further illustrates that when the lower and upper jaws areclosed the jaws can define a continuous track for the shuttle 14 suchthe lower jaw track 66 and the upper jaw track 64 are continuous withone another. The tracks of the upper jaw and bottom jaw can form acontinuous path when the jaw structure 28 is in a closed configuration.

FIG. 35 further illustrates that the first jaw tip (e.g., jaw tip 46,jaw tip 206) can be configured to interdigitate with the second jaw tip(e.g., jaw tip 48, jaw tip 198). For example, the first jaw tip caninterdigitate with and be adjacent or in contact with the second jaw tipwhen the jaw structure 28 is in a closed configuration. The jaw tips canbe sharpened. The jaw tips can be tapered. The jaw tips can be sharp andseat into each other to form a continuous track when the jaw structure28 is in a closed configuration. The jaw tips can seat into each otherto connect the lower and upper jaw tracks 66, 64 to each other.

FIG. 36A illustrates that the shuttle 14 can have a shuttle first tip164 a and a shuttle second tip 164 b.

FIG. 36A further illustrates that the shuttle 14 can have zero, one, ormultiple shuttle holes 405, for example, 1 to 6 or more shuttle holes405, including every 1 shuttle hole increment within this range (e.g., 2shuttle holes, 4 shuttle holes). The shuttle 14 can have a first shuttlehole 405 a and a second shuttle hole 405 b. The shuttle holes 405 (e.g.,holes 405 a and 405 b) can be the same as or different from the sutureholes 404 (e.g., holes 404 a and 404 b). The male and/or female stops412, 416 can move into and out of the shuttle holes 405, the sutureholes 404, or any combination thereof, for example, via flexing,bending, translating, and/or rotating into and out of the holes 405and/or 404.

FIG. 36A further illustrates that the male stops 412 can have one ormultiple bends 426. For example, FIG. 36A illustrates that the malestops 412 can have a first bend 426 a and a second bend 426 b. The malestops 412 can have inflection points 426 _(IF) where the curvature ofthe male stop 412 changes direction or its concavity. For example, FIG.36A illustrates that the male stops 412 can have an inflection point 426_(IF) between two bends 426 (e.g., between the first and second bends426 a, 426 b) where the male stops 412 change concavity (e.g., fromconcave up for the first bend 426 a to concave down for the second bend426 b as shown in FIG. 36A).

FIG. 36A further illustrates that one or more magnets 428 can beattached to or integrated with the male stops 412 on a first side of thedetents, for example, on or under the first surface 414 (also referredto as a male surface). The magnets 428 can be configured to bemagnetically attracted to a magnet attached to or integrated with theupper or lower jaw having an opposite dipole as the magnets 428.

FIG. 36B illustrates that the one or more magnets 428 can be attached toor integrated with a second surface 415 of the male stops 412, forexample, to an underside of the male stops 412.

FIG. 36B further illustrates that there can be a gap G on each side ofthe male stop 412 between the male stop 412 and the shuttle body 160.The gap G can advantageously inhibit or prevent pressure from forming inthe jaws by allowing gas, liquid, or solids to flow or pass through thegap G as the shuttle 14 is advanced into the jaws. There can be a gap oneach lateral side of the male stop 412 as shown in FIG. 36B. As anotherexample, there may not be any gaps G between the male stops 412 and theshuttle body 160, or the gap G can be on only one side of the male stop412 instead of both sides as shown in FIG. 36B. The gaps G can have agap width G_(W) that can be, for example, constant (e.g., as shown inFIG. 36B) or tapered. As another example, the gaps G can have multiplegap widths G_(W). For example, FIG. 36B further illustrates that the gapG can have a constant width, for example, as measured between thelateral edge or surface of the male stop 412 and the lateral edge orsurface of the shuttle body 160.

FIG. 36B further illustrates that the terminal tips 165 can have asharpened edge. The sharpened edge can be configured to pierce tissue.

FIG. 36C illustrates that the male stops 412 (e.g., first and secondmale stops 412 a, 412 b) can extend away from a longitudinal axis of theshuttle 14 out of the plane of the shuttle spine 160.

The shuttle longitudinal axis (e.g., longitudinal axis 157) can be flator curved. FIG. 36C illustrates that the shuttle radius of curvature 154can be from about 2.00 mm to about 5.00 mm or more, including every 0.01mm increment within this range (e.g., 2.84 mm).

The shuttle 14 can be straight or have a preformed bend or curve (e.g.,having the radius of curvature 154). The shuttle 14 can have a preformedbend having a radius of curvature of about 40% to about 200% of theradius of curvature 154, including every 1% increment within this range(e.g., 50%).

The curvature of the shuttle 14 can be constant. The curvature of theshuttle 14 can be fixed. The shuttle 14 can be flexible. The shuttle 14can be rigid. The shuttle 14 can transition between curved and straightconfigurations. Having a preformed bend within this range can reduce thestrain on the shuttle 14. For example, the strain can be reduced forvariations where the shuttle 14 shifts between straight and curvedconfigurations when moving within and/or between the jaws.

FIGS. 37A-37E illustrate that the shuttle 14 can have the male stops 412arranged as shown. FIGS. 37A-37D illustrate that the male stops 412 canbe arms that extend away from the body of the shuttle 14. FIG. 37Eillustrates that the male stops 412 can be bumps on a surface of theshuttle 14.

FIGS. 38A and 38B illustrate that the shuttle 14 can have one ormultiple female stops 416, for example, first, second, third, and fourthfemale stops 416 a, 416 b, 416 c, and 416 d. The female stops 416 can beslots that extend partially (e.g., a recess) or fully (e.g., a throughhole) through the shuttle spine 160. A male stop 412 can be attached toor integrated with the jaws and can be configured to releasably attachto the female detents shown in FIGS. 38A and 38B.

FIG. 38B further illustrates that the shuttle 14 can have one ormultiple male and female stops 412, 416. For example, the shuttle 14 canhave the first, second, third, and fourth female stops 416 a, 416 b, 416c, and 416 d and can have first, second, third, and fourth male stops412 a, 412 b, 412 c, and 412 d. The male stops 412 (e.g., 412 a, 412 b,412 c, and 412 d) can be configured to releasably attach to female stops416 integrated with or attached to the jaw structure 28, for example,that are in or define a shuttle track (e.g., 64 and 66). The femalestops 416 (e.g., 416 a, 416 b, 416 c, and 416 d) can be configured toreleasably attach to male stops 412 integrated with or attached to thejaw structure 28, for example, that are in or define a shuttle track(e.g., 64 and 66). FIG. 38B further illustrates that the shuttle 14 candefine one or more female stops 416 along the perimeter of the shuttle14. For example, a fifth female stop 416 e can be defined between thefirst and third male stops 412 a, 412 c. As another example, a sixthfemale stop 416 f can be defined between the second and fourth malestops 412 b, 412 d. The shuttle 14 can have any combination of maleand/or female stops (e.g., 412 a, 412 b, 412 c, 412 d, 416 a, 416 b, 416c, 416 d, 416 e and/or 416 f).

FIGS. 38B and 38C illustrates that the shuttle 14 can have male and/orfemale stops (e.g., male and/or female stops 412, 416) that extend awayfrom a longitudinal axis of the shuttle 14 along a first transverse axisparallel to the plane of the shuttle spine 160. FIG. 38C illustratesthat the male and/or female stops (e.g., male and/or female stops 412,416) can stay within the plane of the shuttle spine 160 along a secondtransverse axis perpendicular to the first transverse axis.

FIG. 39A illustrates that the lower jaw and upper jaw pushers 76, 86 canhave a straight configuration.

FIG. 39B illustrates that the lower jaw and upper jaw pushers 76, 86 canbe bendable and take on a curved configuration, for example, when in oneor both of the jaw tracks (66 and 64). The lower and upper jaw pushers76, 86 can change to and from the straight configuration and the curvedconfiguration as the pusher is translated through one or both of the jawtracks (e.g., 66 and 64). A proximal portion can remain straight and adistal portion can change from the straight and curved configurations.The pushers can have a pusher radius of curvature 432 of about 1.00 mmto about 5.00 mm, including every 0.01 mm increment within this range(e.g., 2.84 mm). The pusher radius of curvature 432 can be a maximumpusher radius of curvature.

FIG. 39C illustrates that the lower jaw and upper jaw pushers 76, 86 canhave a preformed curve 434. The preformed curve 434 can have a preformedpusher radius of curvature 436 of about 2.00 mm to about 10.00 mm,including every 0.01 mm increment within this range (e.g., 5.84 mm). Theshuttle 14 can have a preformed bend having a radius of curvature ofabout 40% to about 200% of the radius of curvature 154, including every1% increment within this range (e.g., 50%). Preforming the pushers witha curve can advantageously reduce the strain on the pushers when theytransition from a straight to a curved configuration or when thetransition from a less curved configuration to a more curvedconfiguration and vice versa. For example, a pusher manufactured with apreformed curve having a radius of curvature 50% of the maximum pusherradius of curvature can reduce the strain on the pushers by 50%.

FIG. 39D illustrates that the preformed lower jaw and upper jaw pushers76, 86 can be bendable and take on more and less curved configurations,for example, when in one or both of the jaw tracks (66 and 64). They canchange to and from a straight configuration shown in FIG. 39A and thecurved configuration shown in FIG. 39D. The lower and upper jaw pushers76, 86 can change to and from the straight configuration and the curvedconfiguration as the pusher is translated through one or both of the jawtracks (e.g., 66 and 64). A proximal portion can remain straight and adistal portion can change from the straight and curved configurations.

FIGS. 40A-40D are perspective views of the pushers illustrated in FIGS.39A-39D, respectively. FIGS. 40B-40D illustrate that the pushers 76 and86 can have the shuttle seats 274 as shown. The shuttle seats 274 can bea male or female shape and inverse to the shape of the shuttle tips 164.For example, FIGS. 40B-40D illustrate that the shuttle seats 274 canhave a notch shape configured to receive a shuttle tip 164. The shuttleseat 274 can have a beveled or non-beveled surface 438 configured topush against the terminal distal surface of the shuttle tips 164, forexample, against the non-beveled surfaces 406, against beveled surfaces,or both.

The preformed pushers 76 and 86 can be formed with or without slots. Forexample, the slots can be longitudinally coincidental or longitudinallyalternating lateral slots cut into the sides of the pusher, similar tothe shape of the shuttle lateral slots 158.

FIGS. 41A-41E illustrate that the non-preformed and preformed pushers 76and 86 can have one or more slots 440 and/or one or more fenestrations442. The slots 440 can be similar to the shape of the shuttle lateralslots 158 or they can be different. The slots 440 can extend partially(e.g., a recess) or fully (e.g., a through slot) through the pushers.The fenestrations 442 can extend partially (e.g., a recess) or fully(e.g., a though hole) through the pushers. The slots 440 can have alongitudinal component and/or a transverse component relative to apusher longitudinal axis 444. The fenestrations 442 can have a constantcross sectional area, a tapered cross-sectional area, or both. Thefenestrations 442 can have a regular or irregular shape, for example,curved, polygonal, or both. The fenestrations 442 can be defined by oneor more curved surfaces or curved edges, for example, one or more curvedsurfaces or curved edges of the pusher. The fenestrations 442 can have across-sectional shape of a circle, ellipse, rectangle, stadium,horseshoe, star, slot, or any combination thereof. The pushers 76 and 86can have any combination of features illustrated in FIGS. 41A-41E.

FIG. 41A illustrates that the slots 440 can be lateral slots.

FIG. 41B illustrates that the slots 440 can be longitudinal slots.

FIG. 41C illustrates that the slots 440 can be lateral slots,longitudinal slots, and/or extend in a longitudinal and transversedirection relative to the pusher longitudinal axis 444. FIG. 41C furtherillustrates that the pushers can have curved and polygonal fenestrations442 (e.g., circular and/or rectangular fenestrations 442).

FIG. 41D illustrates that the fenestrations 442 can be in thelongitudinal center of the pushers, on the edge of the pushers, inbetween the center and edge of the pushers, or any combination thereof.FIG. 41D further illustrates that the shuttle seat 274 can have a curvedsurface or edge.

FIGS. 41A, 41B, 41E and 41F illustrate that the distal tip of thepushers 76 and 86 can have slots 440 and/or fenestrations 442.

FIG. 41F illustrates various oriented slots 440 and a fenestration 442through the distal tip of the pushers 76 and 86.

FIGS. 42A-42D illustrate that the pushers 76 and 86 can include multiplelinks 445 connected together, for example, 2 to 50 or more links 445,including every 1 link increment within this range (e.g., 10 links). Thelinks 445 can include a distal terminal link 445 a, multipleintermediate links 445 b and a proximal terminal link 445 c. The links445 can have a male connector 446 (e.g., a ball) and/or a femaleconnector 448 (e.g., a socket). For example, FIG. 42A illustrates thatthe distal terminal link 445 a can have a male or female connector 446,448 (e.g., a female connector 448), that the intermediate links can haveone or multiple (e.g., two) male connectors 446 and one or multiple(e.g., two) female connectors 448, and that the proximal terminal link445 c can have a male or female connector 446, 448 (e.g., a maleconnector 446). The links 445 can allow the pushers 76 and 86 to bebendable. For example, the links 445 can allow the pushers 76 and 86 toassume the curves shown in FIGS. 39B-39C. As another example, the links445 can be the same or different from the articulated segmentations 286.

FIG. 42B illustrates that the links 445 can have a link thickness 450 ofabout 0.05 mm to about 0.75 mm, including every 0.05 mm increment withinthis range (e.g., 0.15 mm, 0.20 mm, 0.25 mm). The link thickness 450 canbe the same or different from the shuttle tip thickness 408 and/or theshuttle thickness 410. The link thickness 450 can be less than, equalto, or greater than the shuttle tip thickness 408 and/or can be lessthan, equal to, or greater than the shuttle thickness 410. For example,the link thickness 450 can be about 0.30 mm and the shuttle tipthickness 408 and/or the shuttle thickness 410 can be about 0.15 mm, orvice versa.

FIG. 42C illustrates that the distal terminal link 445 a can have ashuttle seat 274 with the shape shown. The shuttle seat can have a firstseat 274 a and a second seat 274 b. The second seat can further preventunwanted movement between the shuttle 14 and the pushers 76 and 86. Thesecond seat 274 b can provide space around distal end of the shuttletips 154 to help prevent or inhibit the pushers and shuttles fromgetting stuck together, for example, due to suction created by thecompression between the two components and the wet tissue environment.

FIG. 42D illustrates that the links can be cut (e.g., laser cut) with acut width 452 of about 0.01 mm to about 0.10 mm, including every 0.01 mmincrement within this range (e.g., 0.02 mm). As another example, thelinks 445 can be separately cut and then permanently or removablyattached together, for example, with a snap fit, friction fit, magneticfit, or any combination thereof.

The shuttle 14, the first pusher 76 (also referred to as the lower jawpusher), the second pusher 86 (also referred to as the upper jaw pusher)can be made from a flexible polymer, such as PEEK, a resilient metalsuch as Nitinol, any material disclosed herein or combinations thereof.The shuttle and pushers 14, 76, 86 can be coated with a strain reducingcoating.

FIG. 43A illustrates that the first jaw tip (e.g., jaw tip 46, jaw tip206) can interdigitate with the second jaw tip (e.g., jaw tip 48, jawtip 198). For example, the first jaw tip can interdigitate with and beadjacent or in contact with the second jaw tip when the jaw structure 28is in a closed configuration. The jaw tips can be sharpened. The jawtips can be tapered. The jaw tips can be sharp and seat into each otherto form a continuous track when the jaw structure 28 is in a closedconfiguration. The jaw tips can seat into each other to connect thelower and upper jaw tracks 66, 64 to each other.

The interdigitatable jaws can align the shuttle tracks 66 and 64, forexample, to form a single continuous track. As another example, theinterdigitatable jaws can align the shuttle tracks 66 and 64 such that aspace is between the shuttle tracks 66 and 64. The interdigitatable jawscan inhibit or prevent the first and second jaws from moving relative toone another when the jaw structure 28 is in a closed configuration, forexample, as shown in FIG. 43A. The movement that can be inhibited orprevented can include any transverse movement away from the longitudinalaxis (e.g., a center longitudinal axis) of the opposing jaw. Theinterdigitatable jaws can pre-pierce tissue. In this way the jaws canact as a track aligner and tissue cutter.

The first jaw tip (e.g., jaw tip 46, jaw tip 206) can have a first jawmotion control 453 having a first jaw seat 454 configured to abut thesecond jaw when the jaw structure 28 is in a closed configuration,tissue cutting surfaces 456 and a tissue relief pocket 458. For example,the first jaw can have first and second cutting surfaces 456 a and 456b. The second jaw tip (e.g., jaw tip 48, jaw tip 198) can have a secondjaw motion control 459 having a second jaw seat 460 configured to abutthe first jaw when the jaw structure 28 is in a closed configuration,tissue cutting surfaces 462 and a tissue relief pocket 464 (not shown).For example, the second jaw can have first and second cutting surfaces462 a and 462 b.

When the jaws moved from an open configuration to a closedconfiguration, the first and second jaw first cutting surfaces 456 a,462 a can slide past one another and cut tissue. When the jaws areclosed, the first and second jaw second cutting surfaces 456 b, 462 bcan slide past one another and cut tissue. When the jaws are in a closedconfiguration, a jaw tooth 463 of the second jaw defining the second jawfirst cutting surface 462 a can abut the first jaw seat 454. When thejaws are in a closed configuration, a jaw tooth 457 of the first jawdefining the first jaw second cutting surface 456 b can abut the firstjaw seat 454. As tissue is cut by the cutting surfaces the tissue reliefpockets 458 and 464 can provide space for cut tissue to move into. Thepockets 458 and 464 can decrease the hole that the jaws create in thetissue (e.g., tissue 74). The tissue relief pockets 458 and 464 allowthe jaws to compress less tissue when the jaws are moved from an openconfiguration to a closed configuration.

FIG. 43B illustrates the jaw tooth 463 of the second jaw seated againstthe motion control 453 of the first jaw. FIG. 43B further illustratesthat the first and second jaw first cutting surfaces 456 a, 462 a cancontact one another when the jaws are in a closed configuration.

FIG. 43C illustrates the tissue relief pocket 464 which can be seenthrough the lateral half 470 a of the first jaw shown as transparent.The other lateral half 470 b of the first jaw is not transparent anddefines the tissue relief pocket 464.

FIG. 43D illustrates a variation of the tissue relief pockets 458 and464. FIG. 43D further illustrates an opening 472 to the second jaw track66.

FIGS. 43E and 43F illustrate the first and second jaws moving frompartially closed configuration to a fully closed configuration.

FIGS. 43G-43I illustrate the first and second jaws sequentially movingfrom partially closed configuration to a fully closed configuration witha shuttle in the lower jaw such that the jaw teeth and the shuttleexposed portion 423 pierce the tissue when the jaws are moved from theconfiguration illustrated in FIG. 43G to the configuration illustratedin FIG. 43I. The shuttle 14 can be any of the shuttles described and/orillustrated herein.

FIG. 43J illustrates a variation of the jaw structure 28 with theshuttle seated in the lower jaw tip.

FIG. 43K illustrates the shuttle 14 in mid-movement between the firstand second jaws as the shuttle is translating in the continuous track(e.g., defined by tracks 66 and 64) from the lower jaw to the upper jaw,or vice versa.

FIG. 43L illustrates the shuttle 14 seated in the lower jaw with theshuttle tip 164 in contact with the shuttle seat 274 of the upper jawpusher 86. This can be the maximum extent that the upper jaw pusher 86can extend such that it remains within the upper jaw track at fullextension, or it can continue to push the shuttle 14 such that the upperjaw pusher 86 extends out of the upper jaw track at full extension. Atfull extension, the upper jaw pusher 86 can extend into the lower jawtrack. For example, the shuttle seat 274 of the upper jaw can extend outof the upper jaw and into the lower jaw track (e.g., track 66).

FIG. 43M illustrates the shuttle 14 seated in the upper jaw with theshuttle tip 164 in contact with the shuttle seat 274 of the lower jawpusher 76. This can be the maximum extent that the lower jaw pusher 76can extend such that it remains within the lower jaw track at fullextension, or it can continue to push the shuttle 14 such that the lowerj aw pusher 76 extends out of the lower jaw track at full extension. Atfull extension, the lower jaw pusher 76 can extend into the upper jawtrack. For example, the shuttle seat 274 of the lower jaw can extend outof the lower jaw and into the upper jaw track (e.g., track 64).

FIGS. 43L and 43M further illustrate that the planes of the of theshuttle and pushers 14, 76, 86 can be flush or substantially flush withone another and/or can be parallel or substantially parallel with oneanother when the shuttle 14 is in contact with the pushers 76 and 86.

FIG. 43N illustrates that shuttle 14 and the pushers 76 and 86 cancontact each other out of plane with one another such that the shuttleand pushers 14, 76, 86 are at an angle with one another when the shuttle14 is in contact with the pushers 76 and 86.

FIGS. 44A and 44B illustrate a variation of the device 188 in a fullyclosed and fully open configuration, respectively.

FIGS. 44A and 44B illustrate that the jaw control extension 40 can befixed and that the jaws 78 and 80 can move relative to the jaw controlextension 40. For example, the jaws 78 and 80 can move distally andproximally against the jaw control extension 40 to open and close,respectively. The jaws 78 and 80 can move longitudinally along a devicelongitudinal axis 476. The jaws 78 and 80 can move into and out of thecompression cover 34. The jaws 78 and 80 can be attached to a tube 474connected to the handle controls that can translate (e.g., slidablytranslate) the jaws 78 and 80 into and out of the compression cover 34.FIGS. 44A and 44B illustrate that the compression cover 34 can engagewith an upper jaw surface 79 and a lower jaw surface 81 to force thejaws closed when the jaws 78 and 80 are translated proximally toward thehandle and into the compression cover 34. Movement of the jaws 78 and 80in a first direction (e.g., distal movement) against the jaw controlextension 40 can cause the jaws to open and move from the closedconfiguration shown in FIG. 44A to the open configuration shown in FIG.44B. Movement of the jaws 78 and 80 in a second direction (e.g.,proximal movement) against the compression cover 34 can cause the jawsto close and move from the open configuration shown in FIG. 44B to theclosed configuration shown in FIG. 44A. The first and second directionscan be opposite from one another. As another example, the jaws can befixed and the jaw control extension can move relative to the jaws. Thecompression cover 34 can be longitudinally fixed or longitudinallymovable.

The extension head 254 can have the shape shown such that the jaws openrelative to each other when the jaws are moved out of the compressioncover 34 over the extension head 254.

FIG. 44A illustrates the device 188 without a shuttle 14 forillustrative purposes and FIG. 44B illustrates the device 188 of FIG.44A with a shuttle 14.

FIGS. 45A and 45B illustrate a variation of the device 188 in a fullyopened and fully closed configuration, respectively.

FIGS. 45A and 45B illustrate that the handle 104 can have a jaw control8 (also referred to as a trigger), a jaw control release 478 and ashuttle control 479. The jaw control 8 can be pulled with one or morefingers in direction 484 to move the jaw control 8 to the configurationshown in FIG. 45B. The jaw control 8 can translate and/or rotate. Whenthe jaw control 8 is moved in direction 484, the jaws 78 and 80 can movefrom an open configuration to a less open configuration (e.g., to theclosed configuration shown in FIG. 45B). When the jaw control 8 is movedin a direction opposite to direction 484, the jaws 78 and 80 can movefrom a closed configuration to an open configuration (e.g., from theclosed configuration in FIG. 45B to the fully open configurationillustrated in FIG. 45A).

As another example, the handle 104 can have a first press buttonconfigured to close the jaws when pressed and a second press buttonconfigured to open the jaws when pressed.

The jaw control release 478 can be a press button, a switch, a knob, orany combination thereof. The jaw control 8 can lock when the jaws 78 and80 are in the fully closed configuration. Activating the jaw controlrelease 478 can release the jaw control 8 from the lock position. Thejaw control release 478 can be activated, for example, by pressing it.Upon pressing the jaw control release 478, the jaw control 8 can bemanually returned to the position shown in FIG. 45A to fully open thejaws, or the jaw control 8 can automatically return to the positionshown in FIG. 45A.

The shuttle control 479 can be a button, switch, knob, or anycombination thereof. For example, FIGS. 45A and 45B illustrate that theshuttle control 479 can be a switch that can pivot. The shuttle control479 can be locked when the jaws 78 and 80 are in the open configurationof FIG. 45A. When the jaws are closed, the shuttle control can berotated in direction 486 and direction 488. Directions 486 and 488 canbe directed opposite from one another. When the shuttle control 479 ismoved in (e.g., rotated) in direction 486, the upper pusher 86 can movethe shuttle 14 to the lower jaw 80. When the shuttle control 479 ismoved in (e.g., rotated) in direction 488, the lower pusher 76 can movethe shuttle 14 to the upper jaw 78. The shuttle control 479 can have abatwing shape, which can provide ergonomic benefits.

As another example, the handle 104 can have a first press buttonconfigured to move the upper pusher 86 when pressed and a second pressbutton configured to move the lower pusher 76 when pressed.

FIGS. 45A and 45B further illustrate that the device 188 can have aflush port 482 having a luer connection. A cleaning fluid (e.g., enzymecleaner) can be flushed through the device through the flush port 482 toclean it.

FIG. 45C illustrates that the shuttle control 479 can have a neutralposition. When the shuttle control 479 is in the neutral position, oneor neither of the pushers 76 and 86 can be in contact with the shuttle14. When the shuttle control 479 is in the neutral position, the shuttle14 can be ejected from the jaws.

FIG. 45D illustrates the shuttle control 479 in a fully advancedposition when moved in direction 486. When in the shuttle control 479 isin the fully advanced position in direction 486, the upper pusher 86 canbe in a fully advanced position and the lower pusher 76 can be in afully retracted position. For example, the upper pusher 86 can be fullyadvanced toward the lower jaw 80, thereby pushing the shuttle 14 intothe lower jaw 80. The upper pusher 86 can push the shuttle 14 into thelower jaw 80 to the point where detents on the shuttle 14 (male and/orfemale stops 412, 416) releasably engage with detents on the lower jaw80 (male and/or female stops 412, 416).

FIG. 45E illustrates the shuttle control 479 in a fully advancedposition when moved in direction 488. When in the shuttle control 479 isin the fully advanced position in direction 488, the lower pusher 76 canbe in a fully advanced position and the upper pusher 86 can be in afully retracted position. For example, the lower pusher 76 can be fullyadvanced toward the upper jaw 78, thereby pushing the shuttle 14 intothe upper jaw 78. The lower pusher 76 can push the shuttle 14 into theupper jaw 78 to the point where detents on the shuttle 14 (male and/orfemale stops 412, 416) releasably engage with detents on the upper jaw78 (male and/or female stops 412, 416).

FIG. 45F illustrates that the shuttle control 479 can be coupled to anupper pusher slider 492 via linkage 491. The upper pusher slider 492 canbe coupled to the upper pusher 86. FIG. 45F further illustrates that theshuttle control 479 can be coupled to a lower pusher slider 490 vialinkage 489. The lower pusher slider 490 can be coupled to the lowerpusher 76. The upper pusher slider 492 can be moved toward the jaws whenthe shuttle control 479 is moved in direction 486, and can thereby pushthe upper pusher distal end toward and/or into the lower jaw 80. Thelower pusher slider 490 can be moved toward the jaws when the shuttlecontrol 479 is moved in direction 488, and can thereby push the lowerpusher distal end toward and/or into the upper jaw 78.

FIGS. 45G and 45H illustrate the position of the linkage 491 when theshuttle control 479 is in the positions shown in FIGS. 45D and 45E,respectively.

FIGS. 45I and 45J illustrate a variation of a shuttle control lockingpin 494. The locking pin 494 can lock the shuttle control 494 in placewith the shuttle 14 in the upper or lower jaw when the jaws (e.g., jaws78 and 80) are in the open configuration, for example, as shown in FIG.45A. The jaw control 8 can have a locking pin controller 496 configuredto rotate and/or translate to engage the locking pin 494 and push thelocking pin 494 into a locking pin channel 497 to unlock the shuttlecontrol 479 when the jaw control 8 is pulled and the jaws are in a fullyclosed configuration. The locking pin 494 can be biased into a lockedposition with a biasing element 495 such as a spring.

FIGS. 45K and 45L illustrate that the device 188 can have an overstrokecorrection cam path 502 and an overstroke correction cam 504. When thejaw control release 478 is activated, the jaw control 8 can move indirection 506, which can cause the pusher slider in the fully advancedposition to retract the fully advanced pusher by about 0.2 mm to about1.0 mm to compensate and correct for overstroke caused by the tensileand compressive forces in the various structures between the handle 104and the distal end of the device 188.

FIG. 45M illustrates the jaw control 8 when the jaws are in a fully openconfiguration.

FIGS. 46A-46K illustrate an exploded variation of some of the componentsof the device 188.

FIG. 46A illustrates a variation of a tube 510 of the device 188.

FIG. 46B illustrates a variation of an upper pusher 86.

FIG. 46C illustrates a variation of a lower pusher 76.

FIG. 46D illustrates a variation of a tube 512 of the device 188. Thetube 512 can fit over the tube 510.

FIG. 46E illustrates a variation of a compression cover 34.

FIGS. 46F and 46G illustrate a variation of first and second sides ofthe lower jaw 80.

FIGS. 46H and 46I illustrate a variation of first and second sides ofthe upper jaw 78.

FIG. 46J illustrates a connector 514.

FIG. 46K illustrates pins 516 for the connector 514.

Throughout this application, the upper jaw and the lower jaw can also bereferred to as the first jaw and the second jaw, respectively.Throughout this application, the upper jaw and the lower jaw can also bereferred to as the second jaw and the first jaw, respectively.

FIGS. 47A-47D illustrate that the device 188 can have one or multipleshuttle stops 520. The device 188 can have, for example, 1-10 or moreshuttle stops 520, including every 1 shuttle stop 520 increment withinthis range (e.g., 1, 2, 3, 4 or more shuttle stops 520). The upper jaw(e.g., jaw 30, jaw 78) and/or the lower jaw (e.g., jaw 38, 80) can eachhave one or multiple shuttle stops 520. The upper jaw can have, forexample, 1-5 or more shuttle stops 520 (e.g., 1, 2, 3, 4, 5, or moreshuttle stops 520). The lower jaw can have, for example, 1-5 or moreshuttle stops 520 (e.g., 1, 2, 3, 4, 5, or more shuttle stops 520). Theupper and lower jaws can have the same number or a different number ofshuttle stops as each other. For example, the lower and upper jaws caneach have 1, 2, 3, or more shuttle stops. FIGS. 47A and 47B illustratethat the lower jaw (e.g., jaw 38, 80) can have a lower jaw shuttle stop520 a configured to releasably engage with the shuttle 14, and FIGS. 47Cand 47D illustrate that the upper jaw (e.g., jaw 30, jaw 78) can have anupper jaw shuttle stop 520 b configured to releasably engage with theshuttle 14. Half of the lower and upper jaws (e.g., a transverse half ofthe lower and upper jaws on one side of the device of the devicelongitudinal axis) in FIGS. 47A-47D is shown transparent so that theshuttle 14 can be more easily seen in the jaw tracks (e.g., lower andupper tracks 66, 64), and so that the shuttle stops 520 (e.g., shuttlestops 520 a and 520 b) can be more easily seen.

The shuttle stops 520 (e.g., the lower jaw shuttle stops 520 a and theupper jaw shuttle stops 520 b) can be a prong, an arm, a protrusion, anextension, a flexure, a detent, a detent flexure, a male detent, or anycombination thereof. The shuttle stops 520 can be straight and/orcurved. The shuttle stops can be open shapes (e.g., bars, arcs, plates)or closed shapes (e.g., ring-shaped). The shuttle stops 520 can beflexible, rigid, or both (e.g., a first portion can be flexible and asecond portion can be rigid). The shuttle stops 520 can be one or moresprings. The shuttle stops 520 can be made from nickel titanium alloys(e.g., Nitinol), stainless steel, composite materials, or anycombination thereof. The shuttle stops 520 can have a shuttle stop firstlongitudinal end 521 a and a shuttle stop second longitudinal end 521 b.The shuttle stop first longitudinal end 521 a can have a shuttle stopfirst longitudinal end terminal end 521 a _(TE). The shuttle stop secondlongitudinal end 521 b can have a shuttle stop second longitudinal endterminal end 521 b _(TE).

FIGS. 47A-47D further illustrate that each shuttle stop 520 (e.g.,shuttle stops 520 a, 520 b) can be in a shuttle stop groove 522. Eachshuttle stop groove 522 can be in a jaw (e.g., first jaw, second jaw,lower jaw, upper jaw). For example, each lower jaw shuttle stop 520 acan be in a lower jaw shuttle stop groove 522 a and each upper jawshuttle stop 520 b can be in an upper jaw shuttle stop groove 522 b. Thelower jaw shuttle stop 520 a can be housed in the lower jaw shuttle stopgroove 522 a and the upper jaw shuttle stop 520 b can be housed in theupper jaw shuttle stop groove 522 b. The shuttle stop grooves 522 canhave a shuttle stop groove opening 523 that opens into the shuttletracks (e.g., lower and upper jaw shuttle tracks 66, 64) such that theshuttle stop grooves 522 intersect with the shuttle tracks. The shuttlestops 520 (e.g., shuttle stops 520 a, 520 b) can extend from the shuttlestop grooves 522 into the shuttle tracks. For example, the shuttle stopgroove opening can be at a longitudinal terminal end of the shuttle stopgroove such that a longitudinal end of the shuttle stop 520 (e.g., 521a, 521 b) can extend out of the shuttle stop grove and into the shuttletrack. In such cases, a longitudinal terminal end of the shuttle stop(e.g., 521 a _(TE), 521 b _(TE)) can be in the shuttle track. As anotherexample, the shuttle stop groove opening can be between a shuttle stopfirst longitudinal terminal end and a shuttle stop second longitudinalterminal end such that a longitudinal medial portion of the shuttle stop520 between the shuttle stop first and second longitudinal terminal endsextends into (e.g., arcs into) the shuttle track. For example, FIGS.47A-47D illustrate that the shuttle stop first longitudinal end 521 acan extend into the shuttle track (e.g., shuttle tracks 66, 64) suchthat the shuttle stop first longitudinal end terminal end 521 a _(TE)can be in the shuttle track. The shuttle stop first longitudinal end 521a can be further from the device longitudinal axis 476 than the shuttlestop second longitudinal end 521 b. The shuttle stop first longitudinalterminal end 521 a can be configured to contact the shuttle 14 when theshuttle is over the shuttle stop 520, for example, when the shuttle 14passes over the shuttle stop 520 and when the shuttle is stationary overthe shuttle stop 520.

The shuttle stop grooves 522 (e.g., grooves 522 a, 522 b) can open intoa curved portion of the shuttle track. The shuttle stop grooves 522(e.g., grooves 522 a, 522 b) can open into a straight portion of theshuttle track. For example, FIGS. 47A and 47B illustrate that the lowerjaw shuttle groove 522 a can intersect the lower jaw shuttle track at acurved portion of the lower jaw shuttle track). FIGS. 47C and 47Dillustrate that the upper jaw shuttle groove 522 b can intersect theupper jaw shuttle track at a curved portion of the upper jaw shuttletrack). As another example, a first shuttle stop groove can open into astraight portion of the first jaw shuttle track and a second shuttlestop groove can open into a curved portion of the first jaw shuttletrack. As yet another example, a first shuttle stop groove can open intoa straight portion of the second jaw shuttle track and a second shuttlestop groove can open into a curved portion of the second jaw shuttletrack.

The shuttle stops 520 (e.g., stops 520 a, 520 b) can be at an angle 528relative to the device longitudinal axis 476. The shuttle stop grooves522 (e.g., grooves 522 a, 522 b) can be at an angle 528 relative to thedevice longitudinal axis 476. An axis 529 through the shuttle stops 520and/or the shuttle stop grooves 522 can intersect with the devicelongitudinal axis at the angle 528. The axis 529 can be a longitudinalaxis (e.g., center longitudinal axis) through the shuttle stops 520,through the shuttle stop grooves 522, or through both. The angle 528 canbe from about 10 degrees to about 170 degrees, or more narrowly, fromabout 10 degrees to about 80 degrees, or yet more narrowly, from about30 degrees to about 60 degrees, including every 1 degree incrementwithin these ranges (e.g., 10 degrees, 30 degrees, 40 degrees, 45degrees, 50 degrees, 60 degrees, 80 degrees).

The angle 528 of the shuttle stops 520 can allow all or a portion of theshuttle 14 to pass the shuttle stops 520 when the shuttle 14 is movedinto the jaws (e.g., along the shuttle tracks), including, for example,distal to proximal along the device longitudinal axis 476. When theshuttle 14 is driven (e.g., pushed, pulled, or both) into the jaws, theshuttle stops 520 can flex, catch the shuttle 14, and hold the shuttle14 in place. The shuttle stops 520 can passively hold the shuttle 14 inplace when an outward force (e.g., a force having a direction oppositeto the direction of the force which drove the shuttle 14 into the jaws)is applied to the shuttle 14. FIGS. 47A and 47B illustrate the inwarddirection 524 and the outward direction 526 for the lower jaw. FIGS. 47Cand 47D illustrate the inward direction 524 and the outward direction526 for the upper jaw. The inward and outward directions 524, 526 can beopposite one another along, for example, the longitudinal axis of theshuttle tracks. The shuttle 14 can be passively retained by the shuttlestop 520, for example, by virtue of the arrangement of the of theshuttle stop 520 relative to the jaw and the shuttle 14. For example,the shuttle stop 520 can passively engage with the shuttle 14 as theshuttle 14 is advanced into the jaw and can be actively disengaged withthe shuttle 14 so that the shuttle 14 can be advanced out of the jaw.

FIGS. 47b and 47D further illustrate that the shuttle 14 can have one ormultiple suture holes 404, for example, first and second suture holes404 a, 404 b. FIGS. 47B and 47D further illustrate that when the shuttle14 is fully advanced into the lower and upper jaws, the shuttle stops520 do not interface with or engage with the suture holes 404 (e.g.,first and second suture holes 404 a, 404 b) or the suture. As anotherexample, when the shuttle 14 is fully advanced into the lower and upperjaws, the shuttle stops 520 can interface with one or more of the sutureholes 404, the suture, or any combination. For example, the shuttlestops 520 can interface with one or more of the suture holes 404 byextending into one or more of the suture holes 404.

FIGS. 47A-47D illustrate that when the shuttle 14 is engaged with theshuttle stop 520 (e.g., stops 520 a, 520 b), a threshold release forcecan be required to release the shuttle 14 from the shuttle stop 520 sothat the shuttle 14 can be moved to the other jaw. The threshold releaseforce can be reached and/or exceed by applying an outward force to theshuttle 14. The outward force can be applied to the shuttle 14 to reachthe release force and to move the shuttle 14 into the other jaw. Whenthe threshold release force is achieved or exceeded, the shuttle 14 canmove (e.g., slide) against the shuttle stop 520 so that the shuttle 14can move out of one jaw and into the other jaw (e.g., from the first jawto the second jaw, and vice versa). When the threshold release force isachieved or exceeded, the static friction between the shuttle stopsurface and the shuttle surface can be overcome with or without theshuttle stop 520 deflecting. Deflection of the shuttle stop 520 caninclude buckling, bending, flexing, compression (e.g., longitudinalcompression, transverse compression, shortening), tension (e.g.,stretching, lengthening) or any combination thereof of the shuttle stop520. When the threshold release force is achieved or exceeded, thestatic friction between the shuttle stop surface and the shuttle surfacecan be overcome with or without one or multiple walls of the shuttlestop groove 522 deflecting. Deflection of the shuttle stop groove 522can include buckling, bending, flexing, lengthening, or any combinationthereof of the shuttle stop groove 522, as well as in any combinationwith or without deformation of one or more of the walls that define theshuttle stop groove 522 due to the shuttle stop 520 being forced againstthe one or more walls when an outward force is applied to the shuttle14. The threshold release force can be from about 1.0 Newton to about10.0 Newtons or more, including every 0.5 Newton increment within thisrange (e.g., 4.0 Newtons, 4.5 Newtons, 5.0 Newtons). As another example,the release force can be from about 0.5 lbs to about 1.5 lbs, includingevery 0.1 lb increment within this range (e.g., 1.0 lb). When theshuttle 14 is in the first jaw, the outward force (e.g., thresholdrelease force) can be toward the second jaw. When the shuttle 14 is inthe second jaw, the outward force (e.g., threshold release force) can betoward the first jaw. When the shuttle 14 is in the first jaw, theoutward force (e.g., threshold release force) can be applied to theshuttle 14 so that the shuttle 14 can move in the shuttle track towardthe second jaw. When the shuttle 14 is in the second jaw, the outwardforce (e.g., threshold release force) can be applied to the shuttle 14so that the shuttle 14 can move in the shuttle track toward the firstjaw.

The device 188 can have a shuttle stop releaser (also referred to asshuttle stop controller). The shuttle stop releaser can push on theshuttle stop 520, allowing the shuttle 14 to release from the shuttlestop 520. The shuttle stop releaser can be the shuttle 14. For example,the release force can be applied to the shuttle 14 (e.g., via a pusher)to release the shuttle 14 from the shuttle stop 520 such that theshuttle 14 can be the shuttle stop releaser. The release force can beapplied to the shuttle 14 (e.g., from a pusher) to release the shuttle14 from the shuttle stop 520 such that the shuttle 14 functions both asthe shuttle 14 (e.g., carrying the suture back and forth between thejaws) and as the shuttle stop releaser. As another example, the shuttlestop releaser may not be the shuttle 14, whereby the shuttle stopreleaser can selectively engage and disengage with the shuttle stop 520.In such cases, the shuttle stop releaser can reduce or eliminate thethreshold release force that can be required to release the shuttle 14from the shuttle stop 520 so that the shuttle 14 can be moved to theother jaw. The shuttle stop releaser can selectively engage anddisengage with the shuttle stop 520 when the shuttle 14 is in contactwith the shuttle stop 520. The shuttle stop releaser can selectivelyengage and disengage with the shuttle stop 520 when the shuttle 14 isnot in contact with the shuttle stop 520. The shuttle stop releaser canselectively engage and disengage with the shuttle stop 520 before anoutward force is applied to the shuttle 14 (e.g., via the pusher), whilean outward force is applied to the shuttle 14 (e.g., via the pusher),after an outward force is applied to the shuttle 14 (e.g., via thepusher), or any combination thereof. The shuttle stop releaser canselectively engage and disengage with the shuttle stop 520 before aninward force is applied to the shuttle 14 (e.g., via the pusher), whilean inward force is applied to the shuttle 14 (e.g., via the pusher),after an inward force is applied to the shuttle 14 (e.g., via thepusher), or any combination thereof. For example, when the shuttle 14 isfully advanced into the first jaw and the shuttle 14 is engaged with theshuttle stop 520, the shuttle stop releaser can push on the shuttle stop520 to release the shuttle 14 from the grip of the shuttle stop 520.

FIG. 47A further illustrates that when the shuttle 14 is moved into ajaw (e.g., the lower jaw 38, 80), the shuttle 14 can contact and slideover the shuttle stop 520. When the shuttle 14 contacts and slides overthe shuttle stop 520 as the shuttle can move in direction 524, theshuttle stop 520 can deflect, or both. For example, the shuttle stopfirst longitudinal end 521 a can deflect in a deflection firstdirection. The deflection first direction can have a translationcomponent, a rotation component, or both. For example, FIG. 47Aillustrates the deflection first direction can include rotation 530 a,translation 531 a, or both rotation 530 a and translation 531 a. Therotation 530 a can be clockwise rotation in the orientation shown inFIG. 47A, and the translation 531 a can be translation to the right inthe orientation shown in FIG. 47A. FIG. 47A further illustrates thatwhen the shuttle is in a fully advanced position in the jaw (e.g., thelower jaw 38, 80), the shuttle stop 520 can be deflected in the firstdirection. When the shuttle 14 slides against the shuttle stop 520 indirection 524, the shuttle stop 520 can have a shuttle stop firstdeflected position. When the shuttle 14 is fully advanced into the jawand is in contact with the shuttle stop 520, the shuttle stop can havethe shuttle stop first deflected position.

FIG. 47A further illustrates that when the shuttle 14 is moved out of ajaw (e.g., the lower jaw 38, 80), the shuttle 14 can contact and slideover the shuttle stop 520. The shuttle 14 can translate over and pastthe shuttle stop 520 when the shuttle 14 overcomes the threshold releaseforce and/or when the shuttle stop releaser disengages the shuttle stop520 from the shuttle 14. When the shuttle 14 contacts and slides overthe shuttle stop 520 as the shuttle moves in direction 526, the shuttlestop 520 can deflect. For example, the shuttle stop first longitudinalend 521 a can deflect in a deflection second direction. The deflectionsecond direction can have a translation component, a rotation component,or both. For example, FIG. 47A illustrates the deflection seconddirection can include rotation 530 b, translation 531 b, or bothrotation 530 b and translation 531 b. The rotation 530 b can becounterclockwise rotation in the orientation shown in FIG. 47A, and thetranslation 531 b can be translation to the left in the orientationshown in FIG. 47A. When the shuttle 14 slides against the shuttle stop520 in direction 526, the shuttle stop 520 can have a shuttle stopsecond deflected position. When the shuttle is fully retracted oradvanced past the shuttle stop 520, the shuttle stop 520 can be in ashuttle stop neutral position. The shuttle stop neutral position can bea position between the shuttle stop first deflected position and theshuttle stop second deflected position.

FIG. 47A further illustrates that when the shuttle stop firstlongitudinal end 521 a deflects, the shuttle stop second longitudinalend 521 b can be fixed. When the shuttle stop first longitudinal end 521a deflects, the shuttle stop second longitudinal end 521 b can deflect.

FIG. 47C further illustrates that when the shuttle 14 is moved into ajaw (e.g., the upper jaw 30, 78), the shuttle 14 can contact and slideover the shuttle stop 520. When the shuttle 14 contacts and slides overthe shuttle stop 520 as the shuttle can move in direction 524, theshuttle stop 520 can deflect, or both. For example, the shuttle stopfirst longitudinal end 521 a can deflect in a deflection firstdirection. The deflection first direction can have a translationcomponent, a rotation component, or both. For example, FIG. 47Cillustrates the deflection first direction can include rotation 530 a,translation 531 a, or both rotation 530 a and translation 531 a. Therotation 530 a can be clockwise rotation in the orientation shown inFIG. 47C, and the translation 531 a can be translation to the right inthe orientation shown in FIG. 47C. FIG. 47C further illustrates thatwhen the shuttle is in a fully advanced position in the jaw (e.g., theupper jaw 30, 78), the shuttle stop 520 can be deflected in the firstdirection. When the shuttle 14 slides against the shuttle stop 520 indirection 524, the shuttle stop 520 can have a shuttle stop firstdeflected position. When the shuttle 14 is fully advanced into the jawand is in contact with the shuttle stop 520, the shuttle stop can havethe shuttle stop first deflected position.

FIG. 47C further illustrates that when the shuttle 14 is moved out of ajaw (e.g., the upper jaw 30, 78), the shuttle 14 can contact and slideover the shuttle stop 520. The shuttle 14 can translate over and pastthe shuttle stop 520 when the shuttle 14 overcomes the threshold releaseforce and/or when the shuttle stop releaser disengages the shuttle stop520 from the shuttle 14. When the shuttle 14 contacts and slides overthe shuttle stop 520 as the shuttle moves in direction 526, the shuttlestop 520 can deflect. For example, the shuttle stop first longitudinalend 521 a can deflect in a deflection second direction. The deflectionsecond direction can have a translation component, a rotation component,or both. For example, FIG. 47C illustrates the deflection seconddirection can include rotation 530 b, translation 531 b, or bothrotation 530 b and translation 531 b. The rotation 530 b can becounterclockwise rotation in the orientation shown in FIG. 47A, and thetranslation 531 b can be translation to the left in the orientationshown in FIG. 47A. When the shuttle 14 slides against the shuttle stop520 in direction 526, the shuttle stop 520 can have a shuttle stopsecond deflected position. When the shuttle is fully retracted oradvanced past the shuttle stop 520, the shuttle stop 520 can be in ashuttle stop neutral position. The shuttle stop neutral position can bea position between the shuttle stop first deflected position and theshuttle stop second deflected position.

FIG. 47C further illustrates that when the shuttle stop firstlongitudinal end 521 a deflects, the shuttle stop second longitudinalend 521 b can be fixed. When the shuttle stop first longitudinal end 521a deflects, the shuttle stop second longitudinal end 521 b can deflect.

The shuttle stop groove 522 can have a constant width or a taperedwidth. A tapered width can accommodate deflection of the shuttle stopfirst longitudinal end 521 a. As another example, the shuttle stopgroove can have a constant width portion and a tapered width portion.

For example, the portion of the shuttle stop groove 522 that houses theshuttle stop first longitudinal end 521 a can have a tapered width thatgets wider toward the opening 523, and the portion of the shuttle stopgroove 522 that houses the shuttle stop second longitudinal end 521 bcan have a constant width to prevent or minimize deflection of theshuttle stop second longitudinal end 521 b.

FIGS. 47A-47D further illustrate that the shuttle groove 522 can have achamber 532. The chamber 532 can be a shuttle stop deflection chamber, ashuttle stop releaser chamber, or both. When the shuttle stop firstlongitudinal end 521 a deflects, the portion of the shuttle stop 520that is in the chamber 532 can deflect to accommodate deflection of theshuttle stop first longitudinal end terminal end 521 a _(TE) relative tothe rest of the shuttle stop 520 (e.g., shuttle stop 520 a). As anotherexample, the shuttle stop groove 522 can extend across the chamber 532.As yet another example, the upper jaw, the lower jaw, or both, can havea groove first portion 522 a, a groove second portion 522 b, and agroove third portion 522 c. The groove second portion 522 b can includeall or a portion of the chamber 532. As still yet another example, thechamber 532 can be a through-hole. The through-hole can be the terminalend of a shuttle stop releaser track inside the jaws.

FIGS. 47A-47D further illustrate that the lower and upper jaws can havea first suture stop 534 a, a second suture stop 534 b, or both. Thefirst suture stop 534 a can be configured to contact the suture 70. Thefirst suture stop 534 a can be configured to contact the suture loop162. The first suture stop 534 a can function as a primary or secondaryshuttle stop by catching the suture 70 or the suture loop 162. When thesuture 70 or suture loop 162 is in contact the first suture stop 534 a,further movement of the shuttle 14 into the jaw can be inhibited orprevented. The second suture stop 534 b can be configured to contact thesuture 70. The second suture stop 534 b can be configured to contact thesuture loop 162. The second suture stop 534 b can function as a primaryor secondary shuttle stop by catching the suture 70 or the suture loop162. When the suture 70 or suture loop 162 is in contact the secondsuture stop 534 b, further movement of the shuttle 14 into the jaw canbe inhibited or prevented. The first and second suture stops 534 a, 534b can inhibit or prevent the suture 70 from entering the shuttle trackbeyond the suture holder slot. The shuttle tracks (e.g., tracks 64 and66) can have a first height 536 a and a second height 536 b. The firstheight 536 a can be greater than the second height 536 b. The firstheight 536 a can decrease to the second height 536 b at the secondsuture stop 534 b, which can be a tapered surface (e.g., smooth ramp) ora vertical surface (e.g., a step). The second height 536 b can be lessthan the first height 536 a, for example, to inhibit or prevent thesuture 70 from be pulled or pushed into the shuttle track beyond thesuture holder slots 238.

FIGS. 47B and 47D further illustrate that that that the shuttle holes404 may not extend over or engage with the shuttle stop 520. As anotherexample, the shuttle holes can extend over and/or engage with theshuttle stop 520.

FIGS. 47B and 47D further illustrate that the shuttle stop firstlongitudinal end terminal end 521 a _(TE) can extend across a width ofthe shuttle 14.

The device 188 can have zero, one, or multiple stops. For example, theshuttle can have zero, one, or multiple stops (e.g., stops 412, 413,416), the upper jaw can have, zero, one, or multiple stops (e.g., stops520), the lower jaw can have zero, one, or multiple stops (e.g., stops520), or any combination thereof.

FIG. 47E illustrates the lower and upper jaws together with half of theupper and lower jaws shown transparent so that the shuttle 14 andshuttle stop 520 can be seen.

FIGS. 47A-47E illustrate the pushers as transparent and/or in aretracted position.

FIG. 47F illustrates that the device 188 can have a shuttle stopcontroller 537 (also referred to as a shuttle stop articulator and ashuttle stop releaser). The shuttle stop controller 537 can have ashuttle stop engager 538. The shuttle stop engager 538 can interact withthe shuttle stop 520, for example, engage and disengage with the shuttlestop 520. The shuttle stop controller 537 can be in the chamber 532. Aportion of the shuttle stop groove 522 can overlap with the chamber 532.For example, the second portion 522 b of the shuttle stop groove 522 canoverlap with the chamber 532. The shuttle stop engager 538 can bemoveable into and out of the shuttle stop groove 522. The shuttle stopengager 538 can be moveable from a first end of the chamber 532 to asecond end of the chamber 532 and vice versa. The shuttle stop engager538 can be moveable from a first end of the chamber 532 toward a secondend of the chamber 532 and vice versa.

FIG. 47G illustrates that the shuttle stop engager 538 can extend acrossa width of the shuttle stop 520.

FIGS. 47F and 47G further illustrate the shuttle stop 520 in a neutralposition in the chamber 532 and the shuttle stop engager 538 in adisengaged position in the shuttle stop groove 522. When the shuttlestop engager 538 is in the disengaged position, for example, as shown inFIGS. 47F and 47G, the shuttle stop engager 538 may or may not contactthe shuttle stop 520. For example, FIGS. 47F and 47G illustrate thatwhen the shuttle stop engager 538 is in the disengaged position, theshuttle stop engager 538 does not contact the shuttle stop 520. When theshuttle stop 520 is in the neutral position, for example, as shown inFIGS. 47F and 47G, the shuttle stop 520 can be partially deflected orhave zero deflection. For example, FIGS. 47F and 47G illustrate thatwhen the shuttle stop 520 is in the neutral position, the shuttle stop520 can have a non-deflected configuration (also referred to as arelaxed configuration).

When the shuttle stop engager 538 is in a disengaged position, FIG. 47Fillustrates that the shuttle stop engager 538 can be moved in direction539 a (e.g., toward the shuttle stop 520) to interface with or engagethe shuttle stop 520. When the shuttle stop engager 538 engages (e.g.,pushes against) the shuttle stop 520, the shuttle stop 520 can deflect(e.g., flex), allowing the shuttle 14 to release. When the shuttle stopengager 538 is in an engaged position, FIG. 47F illustrates that theshuttle stop engager 538 can be moved in direction 539 b (e.g., awayfrom the shuttle stop 520) to disengage with the shuttle stop 520.

FIGS. 47F and 47G further illustrate that the chamber 532 can have adeflection space 532 _(D). A portion of the shuttle stop 520 (e.g., amiddle portion of the shuttle stop 520 between the shuttle stop firstand second end terminal ends 521 a _(TE), 521 b _(TE)) can bedeflectable into the deflection space 532 _(D), for example, via theshuttle stop engager 538, via the shuttle 14, or via both.

FIGS. 47F and 47G further illustrate that the shuttle 14 can be in theother jaw. As another example, FIGS. 47F and 47G further illustrate thatthe shuttle 14 is in the jaw shown but is transparent.

FIGS. 47F and 47G further illustrate that half of the jaw (e.g., atransverse half on one side of the device longitudinal axis 476) isshown transparent.

FIGS. 47F and 47G illustrate the pushers as transparent and/or in aretracted position.

The jaw shown in FIGS. 47F and 47G can be the upper jaw. The jaw shownin FIGS. 47F and 47G can be the lower jaw.

FIG. 47H illustrates an exemplary shuttle stop 520 having the shape andfeatures shown. The shuttle stop can be, for example, a rod or a plate.For example, FIG. 47H illustrates that het shuttle stop 520 can be aflexible plate.

FIGS. 47I and 47J illustrate the shuttle stop 520 and the shuttle 14engaged with one another. The shuttle stop 520 can become engaged withthe shuttle 14 when the shuttle 14 is moved or attempted to be moved(e.g., pushed, pulled) out of the jaws in direction 526 from an advancedposition in the jaw, similar to how a speed nut functions. The advancedposition in the jaw shown in FIGS. 471 and 47J can be a partiallyadvanced position of the shuttle 14 in the shuttle track or a fullyadvanced position of the shuttle 14 in the shuttle track. When theshuttle stop 520 is engaged with the shuttle 14 (e.g., when in apartially or fully advanced position), the shuttle stop 520 can preventor inhibit the shuttle 14 from being moved (e.g., pulled, pushed) out ofthe jaws in direction 526. When the shuttle stop 520 is engaged with theshuttle 14 (e.g., when in a partially advanced position), the shuttlestop 520 can allow the shuttle 14 to be moved (e.g., pulled, pushed)further into the jaws in direction 524, for example, until the fullyadvanced position is reached. For example, when the shuttle 14 isengaged with the shuttle stop 520, shuttle movement in the outwarddirection 526 toward the other jaw is prevented or inhibited. FIGS. 471and 47J illustrate the shuttle 14 trying to be moved out of the and intothe other jaw (e.g., from the first to second jaw) in direction 526 butthe shuttle 14 is inhibited or prevented from moving in or movingfurther in direction 526 until the shuttle stop 520 is disengaged fromthe shuttle 14 (e.g., via the shuttle stop engage 538), and/or until thethreshold release force is reached between the shuttle 14 and theshuttle stop 520.

To engage the shuttle 14 with the shuttle stop 520, the shuttle 14 canmove a shuttle capture distance of about 0.25 mm to about 2.00 mm alongthe shuttle track in direction 526, including every 0.05 mm and 0.25 mmincrement within this range, for example, from the fully advancedposition to a partially advanced position, or from a first partiallyadvanced position to a second partially advanced position where thefirst partially advanced position is closer to the fully advancedposition than the second partially advanced position. The shuttlecapture distance can be the distance that the shuttle 14 can move indirection 526 until the shuttle stop 520 fully inhibits or preventsfurther movement along direction 526. The shuttle capture distance canbe the activation distance that the shuttle 14 can move in the shuttletrack (e.g., in direction 526) before the movement of the shuttle 14fully engages with the shuttle stop 520, thereby inhibiting orpreventing further movement along direction 526 until the shuttle stop520 is disengaged from the shuttle 14.

FIG. 47I further illustrates that when the shuttle stop 520 and theshuttle 14 engaged with one another, the shuttle stop 520 can haveshuttle stop first deflected configuration, where the shuttle stop firstlongitudinal end 521 a (e.g., the shuttle stop first longitudinal endterminal end 521 aTE) has been deflected in the deflection seconddirection (e.g., rotation 530 b, translation 531 b, or both rotation 530b and translation 531 b). The force of the shuttle 14 against theshuttle stop 520 when shuttle 14 is moved in direction 526 to activateor otherwise engage shuttle stop 520 can cause the shuttle stop firstlongitudinal end 521 a (e.g., the shuttle stop first longitudinal endterminal end 521 aTE) to deflect in the deflection second direction(e.g., rotation 530 b, translation 531 b, or both rotation 530 b andtranslation 531 b), for example, from the shuttle stop neutralconfiguration (e.g., shown in FIGS. 47F-47H) to the shuttle stop firstdeflected configuration, or from a shuttle stop second deflectedconfiguration to the shuttle stop first deflected configuration. Thesecond deflected configuration can be the configuration of the shuttlestop 520 when the shuttle stop first longitudinal end 521 a (e.g., theshuttle stop first longitudinal end terminal end 521 a _(TE)) has beendeflected in the deflection first direction (e.g., rotation 530 a,translation 531 a, or both rotation 530 a and translation 531 a), whichcan occur, for example, when the shuttle 14 is moved over the shuttlestop 520 in direction 524 during advancement of the shuttle 14 into thejaw, and/or when the shuttle 14 is in a static position over the shuttlestop 520 after having been partially or fully advanced into the jaw.

FIG. 47J further illustrates that the shuttle stop engager 538 canextend across a width of the shuttle stop 520.

FIGS. 471 and 47J further illustrate the shuttle stop 520 and theshuttle engager 538 in a disengaged configuration.

FIGS. 471 and 47J further illustrate that half of the jaw (e.g., atransverse half on one side of the device longitudinal axis 476) isshown transparent.

FIGS. 471 and 47J illustrate the pushers as transparent and/or in aretracted position.

The jaw shown in FIGS. 471 and 47J can be the upper jaw. The jaw shownin FIGS. 471 and 47J can be the lower jaw.

FIGS. 47K and 47L illustrate the shuttle stop 520 and the shuttle stopengager 538 engaged with one another. When the shuttle stop 520 and theshuttle stop engager 538 are engaged with one another, the shuttle stopfirst longitudinal end 521 a (e.g., the shuttle stop first longitudinalend terminal end 521 aTE) may or may not be in contact with the shuttle14. For example, FIGS. 471 and 47J illustrate that when the shuttle stop520 and the shuttle stop engager 538 are engaged with one another, aportion of the shuttle stop first longitudinal end 521 a (e.g., theshuttle stop first longitudinal end terminal end 521 aTE) can be incontact with the shuttle 14. To engage the shuttle stop engager 538 withthe shuttle stop 520, the shuttle stop engager 538 can be moved in thechamber 532 toward the shuttle stop 520 (e.g., in direction 539 a). Whenthe shuttle stop engager 538 engages (e.g., pushes against) the shuttlestop 520, the shuttle stop engager 538 can deflect (e.g., flex, bend,buckle) the shuttle stop 520, allowing the shuttle 14 to release. Forexample, the shuttle stop engager 538 can flex or bend a middle portionof the shuttle stop 520 such that the shuttle stop first longitudinalend 521 a can deflect away from the shuttle 14, for example, in thedeflection first direction (e.g., rotation 530 a, translation 531 a, orboth rotation 530 a and translation 531 a). The shuttle stop engager 538can deflect the shuttle stop 520 from the shuttle stop first deflectedconfiguration to the shuttle stop neutral configuration. As anotherexample, the shuttle stop engager 538 can deflect the shuttle stop 520from the shuttle stop first deflected configuration to the shuttle stopsecond deflected configuration. As yet another example, the shuttle stopengager 538 can deflect the shuttle stop 520 from the shuttle stop firstdeflected configuration to any deflected position resulting fromdeflection in the deflection first direction (e.g., rotation 530 a,translation 531 a, or both rotation 530 a and translation 531 a), forexample, deflected configurations between the shuttle stop firstdeflected configuration and the shuttle stop neutral configuration, anddeflected configurations between the shuttle stop neutral configurationand the shuttle stop second deflected configuration. FIGS. 47K and 47Lfurther illustrate that the chamber 532 can have a deflection space 532Dfor the middle portion of the shuttle stop 520 to deflect into when theshuttle stop 520 is disengaged from the shuttle 14 via engagement withthe shuttle stop engager 538. To disengage the shuttle stop engager 538from the shuttle stop 520, the shuttle stop engager 538 can be moved inthe chamber 532 away from the shuttle stop 520 (e.g., in direction 539b).

FIG. 47L illustrates that the shuttle stop engager 538 can extend acrossa width of the shuttle stop 520.

FIGS. 47K and 47L further illustrate that half of the jaw (e.g., atransverse half on one side of the device longitudinal axis 476) isshown transparent.

FIGS. 47K and 47L illustrate the pushers as transparent and/or in aretracted position.

The jaw shown in FIGS. 47K and 47L can be the upper jaw. The jaw shownin FIGS. 47K and 47L can be the lower jaw.

FIG. 47M illustrates that the shuttle stop controller 537 can have acontrol arm 540. The shuttle stop engager 538 can be attached to orintegrated with the control arm 540. The shuttle control arm can beflexible or rigid. The control arm can be, for example, a rod or acable, for example, a release rod or a release cable. The shuttle stopcontroller 537 can be a shuttle stop tape. The control arm 540 canengage and disengage the shuttle stop engager 538 with the shuttle stop520, for example, by moving the shuttle stop engager 538 toward (e.g.,direction 539 a) the shuttle stop 520 and by moving the shuttle stopengager 538 away from (e.g., direction 539 b) the shuttle stop 520,respectively. The shuttle stop controller 537 can be actuated and/orde-actuated by the jaw control extension 40 (also referred to as the jawseparator) or by a mechanism in the handle of the device. For example,the shuttle stop controller 537 can be controlled with one or multipleof the controls in or on the handle of the device, for example, bypushing, pulling, or rotating the controls into a shuttle stopcontroller articulation position. The shuttle stop controller 537 can becontrolled, for example, by being engageable and dis-engageable with thejaw control extension 40 (also referred to as the jaw separator) or by amechanism in the handle of the device. For example, the jaw controlextension 40 or one or multiple of the controls on the handle of thedevice can be releasably engageable with the shuttle stop controller 537(e.g., with the control arm 540) to control movement of the shuttle stopcontroller 537. The shuttle stop controller 537 (and thereby the shuttlestop engager 538) can be actuated by the jaw control extension 40 (alsoreferred to as the jaw separator) or by a mechanism in the handle of thedevice. The jaw separator 40 can control the opening of the jaws, theclosing of the jaws, or both the opening of the jaws and the closing ofthe jaws.

The shuttle stop controller 537 can be straight or curved. For example,FIG. 47M illustrates that the shuttle stop controller 537 can have anL-shape, with the shuttle stop engager 538 as the short leg of theL-shape and the control arm 540 as the long leg of the L-shape.

FIG. 47M further illustrates that the lower or upper jaw is showntransparent and half of the other jaw (e.g., the upper or lower jaw,respectively) is shown transparent so that the shuttle and shuttle stopcontroller 537 can be seen.

FIG. 47M further illustrates the pushers as transparent and/or in aretracted position.

The shuttle 14 and the shuttle stop controller 537 (e.g., shuttle stopengager 538, shuttle stop controller control arm 540) can be in theupper jaw, the lower jaw, or both jaws. The jaw shown in FIG. 47M can bethe lower jaw. The jaw shown in FIG. 47M can be the upper jaw.

FIG. 47N illustrates that the shuttle stop controller 337 (also referredto as shuttle stop tape) can be in a track 542 in the jaw (also referredto as a shuttle stop controller track or controller track). The shuttlestop engager 538, or a portion thereof, can be in the controller track542. The control arm 540, or a portion thereof, can be in the controllertrack 542. The track 542 can be a groove. The track 542 can be achannel. The controller 537 can be advanceable in the track 542 (e.g.,in direction 539 a) and retractable in the track 542 (e.g., in direction539 b). For example, the controller 537 can be advanced and retracted inthe track 542 to engage with and disengage with shuttle stop 520, orvice versa. The controller 337 (e.g., shuttle stop engager 538, controlarm 540, or both) can be moveable (e.g., slideable, translatable) in thecontroller track 542. When the user wants to release the shuttle stop520, the control arm 540 can be slid (e.g., translated) forward in thecontroller track 542 to press the shuttle stop engager 538 against theshuttle stop 520, flexing the shuttle stop 520, for example, from theshuttle stop first deflected configuration to the shuttle stop neutralconfiguration, from the shuttle stop first deflected configuration tothe shuttle stop second deflected configuration. The shuttle stopcontroller 537 can be actuated by the jaw separator 40 or by a mechanismin the handle of the device 188. When the shuttle stop controller 537 isactivated, the shuttle stop controller 537 can be in an advancedposition. When the user wants to capture the shuttle 14 with the shuttlestop 520, the shuttle 14 can be slid (e.g., translated) forward over theshuttle stop 520, for example, while the shuttle stop engager 538 isdisengaged from the shuttle stop 520. When the shuttle stop engager 538is disengaged from the shuttle stop 520, the shuttle stop controller 537can be in a retracted position. The shuttle stop controller advancedposition can be the neutral position of the shuttle stop controller 537.The shuttle stop controller retracted position can be the neutralposition of the shuttle stop controller 537. A position between theadvanced and retracted positions of the shuttle stop controller can bethe neutral position of the shuttle stop controller 537.

The shuttle stop controller 537 may or may not have the short leg of theL-shape. For example, FIG. 47N illustrates the shuttle stop controller537 with the short leg of the L-shape, such as the shape shown in FIG.47M. As another example, FIG. 47N illustrates the shuttle stopcontroller 537 without the short leg of the L-shape (e.g., an l-shape),where the distal terminal end of the control arm 540 can be the shuttlestop engager 538. The portion of the shuttle stop controller 537configured to contact the shuttle stop 520 can be the shuttle stopengager 538. Any portion of the shuttle stop controller 537 configuredto contact the shuttle stop 520 can be the shuttle stop engager 538.

FIG. 47N further illustrates that the chamber 532 can separate from orpart of the controller track 542.

FIG. 47N further illustrates the shuttle stop 520 and the shuttle 14engaged with one another.

FIG. 47N further illustrates the shuttle stop 520 and the shuttle stopengager 538 not engaged with one another.

FIG. 47N further illustrates the shuttle stop controller 537 in adisengaged position such that the shuttle stop 520 is not deflected bythe shuttle stop engager 538. When the shuttle stop controller 537 is ina disengaged position, the shuttle stop controller 537 can be in aretracted position. The retracted position can be the default positionof the shuttle stop controller 537.

FIG. 47N further illustrates that the shuttle stop controller 537 canmove in direction 539 a (e.g., toward the shuttle stop 520) to interfacewith or engage the shuttle stop 520, and that the shuttle stopcontroller 537 can be moved in direction 539 b (e.g., away from theshuttle stop 520) to disengage with the shuttle stop 520.

FIG. 47N further illustrates that half of the jaw (e.g., a transversehalf on one side of the device longitudinal axis 476) is showntransparent. As another example, FIG. 47N further illustrates aremovable cover on the side of the jaw removed. The removable cover canadvantageously improve access to the internal components in the jaws,for example, for repair, replacement, for cleaning, or any combinationthereof. As yet another example, FIG. 47N can be a side view of thedevice 188 such that the controller 537 and the controller track 542 canbe visible without taking a cross-section of the device 188.

The jaw shown in FIG. 47N can be the upper jaw. The jaw shown in FIG.47N can be the lower jaw.

FIG. 47O illustrates the jaw transparent so that the shuttle 14, theshuttle stop 520, and the shuttle stop controller 537 can be seenrelative to one another when the shuttle stop 520 and the shuttle 14engaged with one another, and when the shuttle stop 520 and the shuttlestop engager 538 are not engaged with one another.

FIG. 47P illustrates a perspective view of FIG. 47N with half the jaw(e.g., a transverse half on one side of the device longitudinal axis476) shown transparent so that the shuttle 14 can be seen. FIG. 47Pfurther illustrates that the distal terminal end of the control arm 540can be the shuttle stop engager 538.

FIG. 47Q further illustrates the shuttle stop 520 and the shuttle 14 incontact with one another. As another example, FIG. 47Q furtherillustrates the shuttle stop 520 and the shuttle 14 not in contact withone another.

FIG. 47Q further illustrates the shuttle stop 520 and the shuttle stopengager 538 engaged with one another. When the user wants to engage theshuttle stop engager 538 with the shuttle stop 520 to release theshuttle 14 from the shuttle stop 520, the control arm 540 can be slid(e.g., translated) forward in the controller track 542 to press theshuttle stop engager 538 against the shuttle stop 520 to deflect theshuttle stop 520, for example, from the shuttle stop first deflectedconfiguration to the shuttle stop neutral configuration, from theshuttle stop first deflected configuration to the shuttle stop seconddeflected configuration.

FIG. 47R illustrates the jaw transparent so that the shuttle 14, theshuttle stop 520, and the shuttle stop controller 537 can be seenrelative to one another when the shuttle stop 520 and the shuttle stopengager 538 are engaged with one another.

FIG. 47S illustrates a perspective view of FIG. 47Q with half the jaw(e.g., a transverse half on one side of the device longitudinal axis476) shown transparent so that the shuttle 14 can be seen. FIG. 47Sfurther illustrates that when a first portion of the shuttle stopengager 538 engages with the shuttle stop 538, a second portion of theshuttle stop engager may or may not engage with the shuttle stop 520.For example, FIG. 47S illustrates a second portion of the engager 538(the portion labeled as 538 in FIG. 47S) does not contact the shuttlestop 520 when the first portion of the shuttle stop engager 538 (theportion obscured by the jaw in FIG. 47S) is in contact with the shuttlestop 520.

FIG. 47T illustrates that the shuttle stop controller 337 can have aproximal engager 544 (also referred to as the shuttle stop controllerproximal engager). The proximal engager 544 can be attached to orintegrated with the control arm 540. The proximal engager 544 can be ona proximal end of the controller 337. The proximal engager 544 can be ona proximal terminal end of the controller 337. The proximal engager 544be a protrusion, for example, an arm or a leg, that extends away fromthe control arm 540 and toward the device longitudinal axis 476. Forexample, the proximal engager 544 can be a leg with a notch. The jawcontrol extension 40 or a mechanism in the handle of the device canactivate the shuttle stop controller 537 by engaging with the proximalengager 544. The jaw control extension 40 or a mechanism in the handleof the device can deactivate the shuttle stop controller 537 bydisengaging from the proximal engager 544. For example, FIG. 47Tillustrates that the proximal engager can have a surface 546 that thejaw control extension can engage with. The jaw control extension 40 canhave jaw control extension arms 548. The jaw control extension arms 548can engage with the proximal engager 544, for example, with the surface546. The surface 546 can be part of the notch of the proximal engager544. The notch in the proximal engager can be a catch for the jawcontrol extension 40.

FIG. 47T further illustrates that when the jaws are open, the shuttlestop controller 537 is not engaged with the shuttle stop 520. When thejaws are open, the shuttle stop controller 537 may or may not be incontact with the shuttle stop 520. For example, FIG. 47T illustrateswhen the jaws are open, the shuttle stop controller 537 is not incontact with the shuttle stop 520.

FIG. 47T further illustrates that when the jaws are open, the jawcontrol extension 40 is not engaged with the shuttle stop controller 537(e.g., not engaged with the proximal engager 544 and/or not engaged withthe control arm 540). When the jaws are open, the jaw control extension40 may or may not be in contact with the shuttle stop controller 537(e.g., not engaged with the proximal engager 544 and/or not engaged withthe control arm 540). For example, FIG. 47T illustrates that when thejaws are open, the jaw control extension 40 is not in n contact with theshuttle stop controller 537.

FIG. 47T further illustrates that when the jaws are open, the shuttlestop control 537 can be in a retracted position in the track 542. Whenthe shuttle stop control 537 is in the retracted position in the track542, a first end of the shuttle stop controller 537 (e.g., a first endof the proximal engager 544) can contact and/or rest against a jaw firstsurface 551 a. When the shuttle stop controller 537 is in the retractedposition in the track 542, there can be space 552 (also referred to as agap) between the proximal engager 544 and a jaw second surface 551 b.When the shuttle stop control 537 is in the advanced in the track 542from the retracted position shown in FIG. 47T, the proximal engager 544can be advanced through the space 552 until the second end of theproximal engager 544 contacts the jaw second surface 551 b. The jawfirst surface 551 a can limit movement of the shuttle stop controller537 in direction 539 b. For example, when the first end of the shuttlestop controller 537 (e.g., a first end of the proximal engager 544) isin contact with the jaw first surface 551 a, the shuttle stop controller537 can be in a fully retracted position. The jaw second surface 551 bcan limit movement of the shuttle stop controller 537 in direction 539a. For example, when the second end of the proximal engager 544 is incontact with the jaw second surface 551 b, the shuttle stop controller537 can be in a fully advanced position. The jaw second surface 551 bcan, for example, prevent the shuttle stop controller 537 fromover-deflecting the shuttle stop 520 to release the shuttle stop 520from its engagement with the shuttle 14.

FIG. 47T further illustrates that the jaws can be advanceable indirection 550 a and retractable in direction 550 b. The jaws can bemoveable in directions 550 a and 550 b, for example, translatable orslideable in these directions. The jaws can be moveable relative to thecompression cover 34 and the jaw control extension 40. When the jaws aremoved in directions 550 a and 550 b, the compression cover 34 and thejaw control extension 40 can be in a fixed position. For example, whenthe jaws are advanced and retracted in directions 550 a and 550 b,respectively, the compression cover 34 and the jaw control extension 40can remain fixed such that the jaws can be advanced and retractedrelative to the compression cover 34 and the jaw control extension 40.As another example, when the jaws are moved in directions 550 a and 550b, the jaws, the compression cover 34, the jaw control extension 40, orany combination thereof can be moveable in direction 550 a and/or indirection 550 b. For example, when the jaws are advanced and retractedin directions 550 a and 550 b, respectively, the compression cover 34and the jaw control extension 40 can be moveable in directions 550 aand/or 550 b before, after, or at the same time that the jaws areadvanced or retracted.

FIG. 47T further illustrates the jaws in an open configuration, forexample, a partially open configuration or a fully open configuration.When the jaws are in a partially open configuration, the jaws can bepartially advanced out of the compression cover 34 and over the jawcontrol extension 40 as shown in FIG. 47T. When the jaws are in a fullyopen configuration, the jaws can be in a fully advanced position asshown in FIG. 47T. When the jaws are in a partially open configurationor a fully open configuration, the first end of the shuttle stopcontroller 537 (e.g., a first end of the proximal engager 544) cancontact and/or rest against a jaw first surface 551 a.

FIG. 47T further illustrates that the shuttle stop controller 537 canride in the track 542, and that the track 542 can be in the jaws. Thetrack 542 can be on the exterior side of the jaws (e.g., as shown inFIG. 47T) or on the interior of the jaws.

FIG. 47U illustrates that as the jaws are closed (e.g., are retractedinto the compression cover 34), the jaw control extension 40 can bedriven into the proximal engager 544 in the lower and upper jaws. Forexample, as the jaws are closed, the jaw control extension 40 canpassively make contact with and push against the proximal engager 544 inthe upper and lower jaws. The retraction of the jaws can thereby drivethe shuttle controller 537 into the jaw control extension 40. As anotherexample, FIG. 47U illustrates that as the jaws close (e.g., areretracted into the compression cover 34), the jaw control extension 40can be driven forward into the proximal engager 540 in the lower andupper jaws. The advancement of the jaw control extension 40 can therebybe driven into the shuttle controller 537. For example, as the jawsclose, or after the jaws are closed, the jaw control extension 40 can beadvanced out of the compression cover 34 to make contact with and pushagainst the proximal engager 544 in the upper and lower jaws.

FIG. 47U further illustrates that when the jaws are fully closed and ina partially retracted position, there can be a space 554 (also referredto as a gap) between the distal end of the compression cover 40 and thejaw stops 242. When the jaws are fully closed and in a partiallyretracted position, the jaw control extension 40 can begin to contactthe proximal engager 544 (e.g., the surface 546 of the proximal engager544) that extends from the shuttle stop controller 537. The space 554can have a longitudinal length (e.g., as measure along the devicelongitudinal axis 476) of about 0.01 inches to about 0.10 inches,including every 0.01 inch increment within this range (e.g., 0.02inches).

FIG. 47V illustrates that when the jaws are fully retracted into thecompression cover 34, the jaw stops 242 can contact the distal end ofthe compression cover 40. As the jaws are fully retracted into thecompression cover 34, for example, from the partially retracted positionshown in FIG. 47U, the jaws can move in direction 550 b (e.g., can move0.01 inches to 0.10 inches in direction 550 b) to close the space 554.As the jaws are retracted into the compression cover 34 the finaldistance to close the space 554, the jaws can move the shuttle stopcontroller 537 into the jaw control extension 40 by the same amount. Asthe jaws are retracted into the compression cover 34 the final distanceto close the space 554, the jaw control extension 40 can be drivenforward by the same amount (e.g., as caused by relative movement betweenthe jaws and the jaw control extension 40 when the jaw control extension40 is in a fixed position, or as caused by relative movement between thejaws and the jaw control extension 40 when the jaws are in a fixedposition, or as caused by movement of both the jaws and the jaw controlextension 40). The tips of the jaw control extension arms 548 canthereby drive the shuttle stop controller 537 forward, flexing anddisengaging the shuttle stop 520 from the shuttle 14. This designadvantageously allows the shuttle 14 to be automatically disengaged fromthe shuttle stop 520 once but not before the jaws are fully clamped,where the jaws can be considered fully clamped when the jaws are fullyretracted into the compression cover 34 as shown in FIG. 47V.

As another example, once the jaws are partially retracted into thecompression cover 34 as shown in FIG. 47U, the compression cover 34 canbe moved in direction 550 a (e.g., can move 0.01 inches to 0.10 inchesin direction 550 b) to close the space 554 and fully retract the jawsinto the compression cover 34. As the jaws are retracted into thecompression cover 34 the final distance to close the space 554, the jawscan move the shuttle stop controller 537 into the jaw control extension40 by the same amount.

FIG. 47V further illustrates that when the shuttle stop controller 537is in the advanced position in the track 542, there can be space 553(also referred to as a gap) between the proximal engager 544 and the jawfirst surface 551 a. When the shuttle stop control 537 is retracted inthe track 542 from the advanced position shown in FIG. 47V, the proximalengager 544 can be retracted through the space 553 until the first endof the proximal engager 544 contacts the jaw first surface 551 a. Theshuttle stop control 537 can be retracted when the jaws are opened, forexample, when the jaws are advanced out of the compression cover 34 andover the jaw control extension 40. When the jaws are opened from aclosed configuration, the shuttle stop control 537 can passively retractand return to its retracted position, for example, by sliding indirection 539 b in the track 542. As another example, when the jaws areopened from a closed configuration, the jaw control extension 40 or amechanism in the handle of the device can retract the shuttle stopcontroller 537 by engaging with the proximal engager 544. For example,the proximal engager 44 and the tip of the jaw control extension arms548 can be magnetically attracted to one another such that when the jawsare advanced out of the compression cover 34, the jaw control extension40 can remain attached to the shuttle stop controller 537 as the jawsare advanced. In this way, the jaw control extension 40, while not beingretracted itself, can pull the shuttle stop controller 537 back to theretracted position when the jaws are advanced. Other releasedattachments configurations such as friction fit and snap fitarrangements in addition to or in lieu of the magnets can be used. Suchreleasable engagements between the jaw control extension and the shuttlestop controller 537 can be overcome when the proximal engager 544contacts the jaw first surface 551 a and the jaws continue to beadvanced, for example, to fully open the jaws.

FIG. 47W illustrates that a cover 556 can be placed on the externalsurface of the jaws to contain, shield, and/or protect the shuttle stopcontroller 537. FIG. 47W illustrates a portion of the proximal engager544 can be left exposed when the cover 556 is on the jaws.

FIG. 48A illustrates that the device 188 can have a piercer 558. Thepiercer 558 can have a sharp tip. The piercer 558 can have a sharppoint. Each jaw can house a sharp nitinol or other flexible tape with asharp point (also referred to as the piercer 558). The piercer 558 canbe, for example, a piercer tape. Each jaw can have a piercer track 560that the piercer 558 can be moveable in. For example, the piercer 558can be translatable or slideable in the piercer track 560. The piercer558 can be advanceable and retractable in the piercer track 560. Thefirst jaw can have a piercer track 560. The second jaw can have apiercer track 560.

The piercer 558 can pre-pierce tissue, for example, to provide a pathwayfor the shuttle 14 to pass through. When shuttle 14 is retracted andjaws are closed, the piercer 558 can be driven forward, piercing thetissue. The piercer 558 can then be retracted and the shuttle 14 can bepassed between the jaws.

The device 188 can have one piercer 558. The piercer 558 can be in thefirst jaw or the second jaw. For example, FIG. 48A illustrates that thedevice 188 can have one piercer 558. The piercer 558 can be in the loweror upper jaw. For example, FIG. 48A illustrates that the piercer 558 canbe in the upper jaw.

The device 188 can have two piercers 558, for example, a first piercerand a second piercer. For example, FIG. 48A illustrates that the upperjaw (e.g., jaw 30, 78) can have the piercer 558. The piercer 558 can beextended into the lower jaw (e.g., 38, 80) to pierce the tissue, andthen retracted back into the upper jaw to allow room for the shuttle 14space to pass into the lower jaw.

FIG. 48A further illustrates that the shuttle 14 can be radially outsideof the piercer 558. As another example, the piercer 558 can be radiallyoutside of the piercer 558.

FIG. 48B illustrates the piercer 558 in a partially advanced position.

FIG. 48C illustrates the piercer 558 in a fully advanced position.

FIGS. 48D and 48E illustrates the piercer in a fully retracted position.

FIGS. 48F and 48G illustrate the shuttle 14 being passed from one jaw tothe other after the piercer 558 is advanced to pierce the tissue andthen retracted (e.g., fully retracted) to allow the shuttle 14 to bepassed between the jaws.

FIGS. 48H and 48I illustrate that the device 188 can have a firstpiercer 558 in the upper jaw and a second piercer 558 in the second jaw.

FIGS. 48A-48I further illustrate that the piercer track 560 can mergewith the shuttle track in the lower and upper jaws, for example, so thatthe shuttle 14 can go through the same hole in the tissue that thepiercer 558 created. As another example, the piercer track 560 and theshuttle track in the lower and upper jaws may not merge in the jaws,where the exit angles from the jaw(s) of the piercer 558 and the exitangles from the jaws of the shuttle 14 can cross such that there is lesstissue for the shuttle 14 to pierce through after the piercer 558pre-pierces the tissue. In such cases, the path of the shuttle 14 andthe path of the piercer 558 can cross within space between the jaws.

FIG. 49A illustrates that the male stops 412 can have a male stop firstlongitudinal end 412 _(FE) and a male stop second longitudinal end 412_(SE), and that the male stop first and second longitudinal ends 412_(FE), 412 _(SE) can have different sizes and/or shapes as each other.All or a portion of the male stop first longitudinal end 412 _(FE) canbe, for example, smaller or larger than a portion of the male stopsecond longitudinal end 412 _(SE) along one or multiple dimensions ofthe male stops 412. For example, FIG. 49A illustrates that a portion ofthe male stop second longitudinal end 412 _(SE) can be larger (e.g.,wider, thicker) than a portion of the male stop first longitudinal end412 _(FE) along one or multiple dimensions (e.g., width, thickness) ofthe male stops 412. FIG. 49A illustrates, for example, that the malestops 412 can have a hammerhead shape (also referred to as a T-shape)that has a proximal end (also referred to as the male stop firstlongitudinal end 412 _(FE)) that is smaller (e.g., narrower) than thedistal end (also referred to as the male stop second longitudinal end412 _(SE)).

The male stop first longitudinal end 412 _(FE) and the male stop secondlongitudinal end 412 _(SE) can be first and second longitudinal halvesof the male stops 412. The male stop first and second longitudinal ends412 _(FE), 412 _(SE) can have the same longitudinal length. For example,FIG. 49A illustrates that the male stop first longitudinal end 412 _(FE)can include a first portion of the narrow section of the hammerheadshape and that the male stop second longitudinal end 412 _(SE) caninclude a second portion of the narrow section of the hammerhead shapeand the wide section of the hammer head shape. The male stop first andsecond longitudinal ends 412 _(FE), 412 _(SE) can thereby form theT-shape, with the male stop first longitudinal end 412 _(FE) forming thebase of the T-shape and with the male stop second longitudinal end 412_(SE) forming the top of the T-shape.

FIG. 49A further illustrates that the male stops 412 can have multiplesections 412 _(S) (also referred to as male stop sections 412 _(S))having different sizes and/or shapes as each other, including forexample, 2-10 or more sections 412 _(S), including every 1 sectionincrement within this range (e.g., 2 sections, 3 sections, 10 sections).For example, FIG. 49A illustrates that the male stops 412 can have amale stop first section 412 _(S1) and a male stop second section 412_(S2). The male stop first section 412 _(S1) can have a different sizeand/or shape as the male stop second section 412 _(S2). For example,FIG. 49A illustrates that the male stop first section 412 _(S1) can bethe base of the T-shape and the male top second section 412 _(S2) can bethe top of the T-shape. The male stop first and second sections 412_(S1), 412 _(S2) can have one or multiple different dimensions as eachother. For example, the male stop first section 412 _(S1) can be longer,wider, and/or thicker than the male stop second section 412 _(S2), orvice versa. The male stop second section 412 _(S2) can be longer, wider,and/or thicker than the male stop first section 412 _(S1), or viceversa. For example, FIG. 49A illustrates that the male stop firstsection 412 _(S1) can be narrower than the male stop second section 412_(S2). As another example, FIG. 49A illustrates that the male stop firstsection 412 _(S1) can be longer and narrower than the male stop secondsection 412 _(S2), whereby some of the male stop first section 412 _(S1)is part of the male stop first longitudinal end 412 _(FE), some of themale stop first section 412 _(S1) is part of the male stop secondlongitudinal end 412 _(SE), and all of the male stop second section 412_(S2) is part of the male stop second longitudinal end 412 _(SE). Themultiple sections 412 _(S) can be attached to or integrated with eachother. The sections 412 _(S) can be, for example, monolithically formedwith each other. The male stops 412 and the shuttle body 160 (alsoreferred to as the shuttle spine 160) can be a monolithic structure.

Relative to male stops 412 that have a straight shape or a straightdiving board design (e.g., as shown in FIGS. 33A-36C), male stops 412that have a distal end that is larger (e.g., wider) than their proximalend (e.g., the hammerhead shape shown in FIG. 49A) can increase theretention force of the male stops 412 in the female stops 416 whilekeeping the bending force of the male stops 412 the same relative to astraight shape (e.g., the straight shape shown in FIGS. 33A-36C). Thewider distal end can increase the surface area of the male stops 412that engages with the female stops 416, and the narrower proximal endcan keep the deflection force of the male stops 412 the same (e.g.,relative to the straight male stops 412 in FIGS. 33A-36C that have malestops 412 with proximal and distal ends of equal width). As anotherexample, the larger surface area of the wide distal end of thehammerhead shape can advantageously increase the tactile feedback to theuser of the device 188 by increasing the drag force into and out of thefemale stop 416.

FIG. 49A further illustrates that the male stops 412 can have a malestop first terminal end 412 _(TE1) and a male stop second terminal end412 _(TE2). The male stops 412 can be attached to, integrated with, orintegrally formed with the shuttle 14 such that the male stop firstterminal end 412 _(TE1) can be flush with or coincident with the shuttlebody 160. The male stops 412 can be, for example, extensions of theshuttle body 160 that extend away from and/or along the shuttlelongitudinal axis 14 _(A1). For example, FIG. 49A illustrates that themale stops 412 can be extensions of the shuttle body 160 that extendaway from the shuttle longitudinal axis 14 _(A1). The male stop secondterminal end 412 _(TE2) can be an edge, a surface, or both. The edge canbe straight, curved, or both. The surface can be straight, curved, orboth. For example, FIG. 49A illustrates that the male stop secondterminal end 412 _(TE2) can be a flat surface. FIG. 49A furtherillustrates that the male stop first section 412 _(S1) can have a malestop first section first terminal end 412 _(S1TE1) and a male stop firstsection second terminal end 412 _(S1TE2), and that the male stop secondsection 412 _(S2) can have a male stop second section first terminal end412 _(S2TE1) and a male stop second section second terminal end 412_(S2TE2). As shown in FIG. 49A, the male stop first section firstterminal end 412 _(S1TE1) can be the same as the male stop firstterminal end 412 _(TE1), and the male stop second section secondterminal end 412 _(S2TE2) can be the same as the male stop secondterminal end 412 _(TE2). As further shown in FIG. 49A, the male stopfirst section second terminal end 412 _(S1TE2) can terminate where themale stop second section first terminal end 412 _(S2TE1) begins (e.g.,as designated by the dashed line labeled as the male stop first sectionsecond terminal end 412 _(S1TE2) and the male stop second section firstterminal end 412 _(S2TE1) in FIG. 49A).

FIG. 49A further illustrates that the male stop second longitudinal end412 _(SE) can be closer to a longitudinal center of the shuttle 14(e.g., the suture holder 18) than the male stop first longitudinal end412 _(FE). The male stop second longitudinal end 412 _(SE) can be closerto the suture holder 18 than the male stop first longitudinal end 412_(FE). The male stop first longitudinal end 412 _(FE) can be closer tothe shuttle tip 164 than the male stop second longitudinal end 412_(SE). FIG. 49A further illustrates that the male stop second section412 _(S2) can be closer to the longitudinal center of the shuttle 14than the male stop first section 412 _(S1). The male stop second section412 _(S2) can be closer to the suture holder 18 than the male stop firstsection 412 _(S1). The male stop first section 412 _(S1) can be closerto the shuttle tip 164 than the male stop second section 412 _(S2). FIG.49A further illustrates that the male stop second terminal end 412_(TE2) can be closer to the longitudinal center of the shuttle 14 thanthe male stop first terminal end 412 _(TE1). The male stop secondterminal end 412 _(TE2) can be closer to the suture holder 18 than themale stop first terminal end 412 _(TE1). The male stop first terminalend 412 _(TE1) can be closer to the shuttle tip 164 than the male stopsecond terminal end 412 _(TE2).

One or multiple portions of the male stops 412 can be engageable with afemale stop 416. For example, the male stop second terminal end 412_(TE2) can be engageable with a female stop 416, a surface between themale stop first terminal end 412 _(TE1) and the male stop secondterminal end 412 _(TE2) (e.g., the male surface 414) can be engageablewith a female stop 416, an edge between the male stop first terminal end412 _(TE1) and the male stop second terminal end 412 _(TE2) can beengageable with a female stop 416, or any combination thereof can beengageable with a female stop 416. For example, FIG. 49A illustratesthat the male surface 414 can be engageable with a female stop 416. Themale stop first section 412 _(S1) and/or the male stop second section412 _(S2) can be engageable with a female stop 416. For example, FIG.49A illustrates that the male stop second section 412 _(S2) can beengageable with a female stop 416.

The male stop first section 412 _(S1) can be bendable or deflectable,for example, about the base of the male stops 412 at or near the malestop first terminal end 412 _(TE1) and/or anywhere along the length ofthe male stop first section 412 _(S1). For example, when the male stopsecond section 412 _(S2) is moved into contact with a female stop 416,the male stop first section 412 _(S1) can deflect to allow the male stop412 to pass into the female stop 416. In this way, the female stop 416can passively retain the shuttle 14 in a jaw of the device 188 bypassively retaining the male stop 412. For example, the deflection ofthe male stop first section 412 _(S1) can allow male stop 412 to passinto and out of a female stop 416, and can, for example, allow the malestop second section 412 _(S2) to engage with and disengage with thefemale stop 416. In this way the male stops 412 can be a spring whichcan be deflectable from a neutral or a non-neutral configuration (e.g.,the configuration shown in FIG. 49A) to a compressed configuration ortensed configuration.

FIG. 49A further illustrates that the shuttle 14 can have the shuttlelongitudinal axis 14 _(A1), a shuttle first transverse axis 14 _(A2),and a shuttle second transverse axis 14 _(A3).

The shuttle longitudinal axis 14 _(A1) can be a center longitudinal axisof the shuttle 14 (e.g., as shown in FIG. 49) or can be offset from thecenter longitudinal axis of the shuttle 14. The length of the shuttle 14(e.g., the length of the shuttle 14 as measured between the two terminaltips 165) can be measured along the shuttle longitudinal axis 14 _(A1)or along an axis parallel to the shuttle longitudinal axis 14 _(A1). Forclarity with the other labels shown in FIG. 49A, only a portion of theshuttle longitudinal axis 14 _(A1) is shown in FIG. 49A. The rest of theshuttle longitudinal axis 14 _(A1) in FIG. 49A is shown transparent forillustrative purposes only. The shuttle longitudinal axis 14 _(A1) canextend along the length of the shuttle 14, for example, as shown by theshuttle longitudinal axis 157 (also referred to as the shuttlelongitudinal axis 14 _(A1)) in FIG. 12A or by the shuttle longitudinalaxis 14 _(A1) shown in FIG. 49D.

The shuttle first transverse axis 14 _(A2) can be a center firsttransverse axis of the shuttle 14 or, as shown in FIG. 49A, can beoffset from the center first transverse axis of the shuttle 14. Theshuttle width 292 can be measured along the shuttle first transverseaxis 14 _(A2) or along an axis parallel to the shuttle first transverseaxis 14 _(A2). The shuttle first transverse axis 14 _(A2) can beperpendicular to the shuttle longitudinal axis 14 _(A1). The shuttlefirst transverse axis 14 _(A2) can be straight or curved. For example,FIG. 49A illustrates that the shuttle first transverse axis 14 _(A2) canbe straight. When the shuttle first transverse axis 14 _(A2) is curved,the shuttle 14 can have a first side (e.g., top side) that is convex anda second side (e.g., bottom side) of the shuttle 14 that is concave, orvice versa. A curved shuttle first transverse axis 14 _(A2) can have aradius of curvature. Having a shuttle 14 that has a concave side and aconvex side can advantageously inhibit or prevent lateral movement ofthe shuttle 14 as the shuttle 14 is advanced through tissue, and/or canpromote longitudinal movement of the shuttle 14 as the shuttle 14 isadvanced through tissue.

The shuttle second transverse axis 14 _(A3) can be a center secondtransverse axis of the shuttle 14 or, as shown in FIG. 49A, can beoffset from the center second transverse axis of the shuttle 14. Ashuttle thickness 14 _(T) can be measured along the shuttle secondtransverse axis 14 _(A3) or along an axis parallel to the shuttle secondtransverse axis 14 _(A3). The shuttle thickness 14 _(T) can be the sameas or different from the shuttle tip thickness 408. For example, theshuttle thickness 14 _(T) can be equal to (e.g., as shown in FIG. 49A),greater than, or less than the shuttle tip thickness 408. The shuttlesecond transverse axis 14 _(A3) can be perpendicular to the shuttlelongitudinal axis 14 _(A1). The shuttle second transverse axis 14 _(A3)can be perpendicular to the shuttle first transverse axis 14 _(A2). Theshuttle second transverse axis 14 _(A3) can be straight or curved. Forexample, 49A illustrates that the shuttle second transverse axis 14_(A3) can be straight.

FIG. 49A further illustrates that the male stops 412 can have a malestop longitudinal axis 412 _(A1), a male stop first transverse axis 412_(A2), and a male stop second transverse axis 412 _(A3).

The male stop longitudinal axis 412 _(A1) can be straight and/or curved.For example, FIG. 49A illustrates that when the male stops 412 are in aneutral position, the male stop longitudinal axis 412 _(A1) can becurved in the male stop first longitudinal end 412 _(FE) and can bestraight in the male stop second longitudinal end 412 _(SE). The malestop longitudinal axis 412 _(A1) can be a center longitudinal axis thatextends down the middle of the male stops 412. The male stoplongitudinal axis 412 _(A1) can be in the same plane as the shuttlelongitudinal axis 14 _(A1). The male stops 412 can be symmetrical orasymmetrical about the male stop longitudinal axis 412 _(A1). Forexample, FIG. 49A illustrates that the male stops 412 can be symmetricalabout the male stop longitudinal axis 412 _(A1). The length of the malestops 412 can be measured along the male stop longitudinal axis 412_(A1), for example, between the male stop first terminal end 412 _(TE1)and the male stop second terminal end 412 _(TE2). As further shown inFIG. 49A, the base of the male stop longitudinal axis 412 _(A1) canextend onto and/or extend from the shuttle body 160. The portion of themale stop longitudinal axis 412 _(A1) that extends onto the shuttle body160 can be coincident or parallel to the shuttle longitudinal axis 14_(A1).

The male stop first transverse axis 412 _(A2) can be straight and/orcurved. The male stop first transverse axis 412 _(A2) can beperpendicular to the male stop longitudinal axis 412 _(A1). The malestop first transverse axis 412 _(A2) can be perpendicular to the shuttlelongitudinal axis (e.g., shuttle longitudinal axis 14 _(A1)). The malestops 412 can be symmetrical or asymmetrical about the male stop firsttransverse axis 412 _(A2). For example, FIG. 49A illustrates that themale stops 412 can be asymmetrical about the male stop first transverseaxis 412 _(A2). The width of the male stops 412, for example, the widthof the male stop first section 412 _(S1) and the width of the male stopsecond section 412 _(S2), can be measured along the male stop firsttransverse axis 412 _(A2). The shuttle width 292 can be measured alongthe shuttle first transverse axis 14 _(A2) or along an axis parallel tothe shuttle first transverse axis 14 _(A2). The male stop secondterminal end 412 _(TE2) can be, for example, parallel to the shuttlefirst transverse axis 14 _(A2) (e.g., as shown in FIG. 49A). Forexample, the flat surface of the male stop second terminal end 412_(TE2) can be parallel to the shuttle first transverse axis 14 _(A2).

The male stop second transverse axis 412 _(A3) can be straight and/orcurved. The male stop second transverse axis 412 _(A3) can beperpendicular to the male stop longitudinal axis 412 _(A1). The malestop second transverse axis 412 _(A3) can be perpendicular to the malestop first transverse axis 412 _(A2). The male stops 412 can besymmetrical or asymmetrical about the male stop second transverse axis412 _(A3). For example, FIG. 49A illustrates that the male stops 412 canbe symmetrical about the male stop second transverse axis 412 _(A3)(e.g., a first half of the T-shape can be on a first side of the malestop second transverse axis 412 _(A3) and a second half of the T-shapecan be on a second side of the male stop second transverse axis 412_(A3)). The thickness of the male stops 412 can be measured along themale stop second transverse axis 412 _(A3).

FIG. 49A further illustrates that the male stops 412 can extend from theshuttle body 160. For example, FIG. 49A illustrates that the male stops412 can extend from the shuttle body 160 into and/or over a suture hole(e.g., suture holes 404 a, 404 b), for example, from the male stop firstterminal end 412 _(TE1) to the male stop second terminal end 412 _(TE2).

FIG. 49A illustrates, for example, that the male stops 412 can extendaway from the shuttle body 160 (e.g., extend away from shuttlelongitudinal axis 14 _(A1)), for example, along the male stoplongitudinal axis 412 _(A1). The male stops 412 can extend radiallyand/or longitudinally away from the shuttle longitudinal axis 14 _(A1)along the male stop longitudinal axis 14 _(A1). As shown in FIG. 49A,the male stops 412 can be radial male stops that extend radially awayfrom the shuttle longitudinal axis 14 _(A1), for example, along the malestop longitudinal axis 412 _(A1). As another example, FIG. 49Aillustrates that the male stops 412 can be radial male stops that extendradially away from the shuttle longitudinal axis 14 _(A1) andlongitudinally along the male stop longitudinal axis 412 _(A1). One orboth of the male stop first and second longitudinal ends 412 _(FE), 412_(SE) can extend away from the shuttle body 160 and/or away from theshuttle longitudinal axis 14 _(A1). For example, FIG. 49A illustratesthat both the male stop first and second longitudinal ends 412 _(FE),412 _(SE) can extend radially away from the shuttle longitudinal axis 14_(A1), for example, along the male stop longitudinal axis 412 _(A1). Asanother example, FIG. 49A illustrates that both the male stop first andsecond longitudinal ends 412 _(FE), 412 _(SE) can extend longitudinallyaway from the shuttle longitudinal axis 14 _(A1), for example, along themale stop longitudinal axis 412 _(A1). As yet another example, FIG. 49Aillustrates that both the male stop first and second longitudinal ends412 _(FE), 412 _(SE) can extend longitudinally away from the shuttlelongitudinal axis 14 _(A1), for example, along the male stoplongitudinal axis 412 _(A1), and can extend radially away from theshuttle longitudinal axis 14 _(A1), for example, along the shuttlesecond transverse axis 14 _(A2). One or both of the male stop first andsecond sections 412 _(S1), 412 _(S2) can extend away from the shuttlebody 160 and/or away from the shuttle longitudinal axis 14 _(A1). Forexample, FIG. 49A illustrates that both the male stop first and secondsections 412 _(S1), 412 _(S2) can extend radially away from the shuttlelongitudinal axis 14 _(A1), for example, along the male stoplongitudinal axis 412 _(A1). As another example, FIG. 49A illustratesthat both the male stop first and second sections 412 _(S1), 412 _(S2)can extend longitudinally away from the shuttle longitudinal axis 14_(A1), for example, along the male stop longitudinal axis 412 _(A1). Asyet another example, FIG. 49A illustrates that both the male stop firstand second sections 412 _(S1), 412 _(S2) can extend longitudinally awayfrom the shuttle longitudinal axis 14 _(A1), for example, along the malestop longitudinal axis 412 _(A1), and can extend radially away from theshuttle longitudinal axis 14 _(A1), for example, along the shuttlesecond transverse axis 14 _(A2).

As another example, the male stop first longitudinal end 412 _(FE) canextend away from (e.g., radially away from) the shuttle longitudinalaxis 14 _(A1), and the male stop second longitudinal end 412 _(SE) canextend toward (e.g., radially toward) the shuttle longitudinal axis 14_(A1). As yet another example, the male stop first longitudinal end 412_(FE) can extend away from the shuttle body 160 parallel to the shuttlelongitudinal axis 14 _(A1) such that the male stop first longitudinalend 412 _(FE) does not radially extend away from the shuttlelongitudinal axis 14 _(A1), and the male stop second longitudinal end412 _(SE) can extend away (e.g., radially away) from the shuttle body160 or the shuttle longitudinal axis 14 _(A1). As yet still anotherexample, the male stop first longitudinal end 412 _(FE) can extend away(e.g., radially away) from the shuttle longitudinal axis 14 _(A1), themale stop second longitudinal end 412 _(SE) can extend parallel to theshuttle longitudinal axis 14 _(A1) such that the male stop secondlongitudinal end 412 _(SE) does not radially extend away from theshuttle longitudinal axis 14 _(A1).

As another example, the male stop first section 412 _(S1) can extendaway from (e.g., radially away from) the shuttle longitudinal axis 14_(A1), and the male stop second section 412 _(S2) can extend toward(e.g., radially toward) the shuttle longitudinal axis 14 _(A1). As yetanother example, the male stop first section 412 _(S1) can extend awayfrom the shuttle body 160 parallel to the shuttle longitudinal axis 14_(A1) such that the male stop first section 412 _(S1) does not radiallyextend away from the shuttle longitudinal axis 14 _(A1), and the malestop second section 412 _(S2) can extend away (e.g., radially away) fromthe shuttle body 160 or the shuttle longitudinal axis 14 _(A1). As yetstill another example, the male stop first section 412 _(S1) can extendaway (e.g., radially away) from the shuttle longitudinal axis 14 _(A1),the male stop second section 412 _(S2) can extend parallel to theshuttle longitudinal axis 14 _(A1) such that the male stop secondsection 412 _(S2) does not radially extend away from the shuttlelongitudinal axis 14 _(A1).

FIG. 49A further illustrates that the male stops 412 can extendlaterally away from and/or toward the shuttle longitudinal axis 14_(A1), for example, along the male stop first transverse axis 412 _(A2).The male stops 412 can, for example, extend laterally toward a shuttlefirst lateral side 14 _(L1) and/or away from a shuttle second lateralside 14 _(L2), for example, along the male stop first transverse axis412 _(A2). FIG. 49A illustrates that the male stop second longitudinalend 412 _(SE) can extend along the male stop first transverse axis 412_(A2) farther than the male stop first longitudinal end 412 _(FE). Afirst side of the male stop second longitudinal end 412 _(SE) can extendaway from male stop first longitudinal end 412 _(FE) toward the shuttlefirst lateral side 14 _(L1) and away from the shuttle second lateralside 14 _(L2). A second side of the male stop second longitudinal end412 _(SE) can extend away from male stop first longitudinal end 412_(FE) toward the shuttle second lateral side 14 _(L2) and away from theshuttle first lateral side 14 _(L1). In this way the male stops 412 candefine the hammerhead shape shown in FIG. 49A. FIG. 49A illustrates thatthe male stop second section 412 _(S2) can extend along the male stopfirst transverse axis 412 _(A2) farther than the male stop first section412 _(S1). A first side of the male stop second section 412 _(S2) (e.g.,on a first side of the male stop longitudinal axis 412 _(A1)) can extendaway from the male stop first section 412 _(S1) toward the shuttle firstlateral side 14 _(L1) and away from the shuttle second lateral side 14_(L2). A second side of the male stop second section 412 _(S2) (e.g., ona second side of the male stop longitudinal axis 412 _(A1)) can extendaway from the male stop first section 412 _(S1) toward the shuttlesecond lateral side 14 _(L2) and away from the shuttle first lateralside 14 _(L1). In this way the male stops 412 can define the hammerheadshape shown in FIG. 49A. FIG. 49A further illustrates that the shuttlelongitudinal axis 14 _(A1) can be a center longitudinal axis such thatthe shuttle first lateral side 14 _(L1) is half of the shuttle 14 on afirst side of the shuttle longitudinal axis 14 _(A1) and the shuttlesecond lateral side 14 _(L2) is half of the shuttle 14 on a second sideof the shuttle longitudinal axis 14 _(A1).

The shuttle first and second lateral sides 14 _(L1), 14 _(L2) can be theportions of the shuttle 14 that are on first and second sides of theshuttle longitudinal axis 14 _(A1) such that the shuttle first lateralside 14 _(L1) is a first lateral half of the shuttle 14 and the shuttlesecond lateral side 14 _(L2) is a second lateral half of the shuttle 14.The shuttle first and second lateral sides 14 _(L1), 14 _(L2) can haveshuttle lateral side terminal ends 14 _(LTE). The shuttle lateral sideterminal ends 14 _(LTE) can be an edge and or a surface. For example,FIG. 49A illustrates that the shuttle lateral side terminal ends 14_(LTE) can be a flat surface which can be, for example, perpendicular tothe top and bottom surfaces of the shuttle 14 (e.g., as shown in FIG.49A) or can be beveled. As FIG. 49A shows, the surfaces 406 and theshuttle lateral side terminal ends 14 _(LTE) can form a surface and/oran edge around the perimeter of the shuttle 14.

FIG. 49A further illustrates that the shuttle 14 can have a shuttlefirst longitudinal side 14 _(S1) and a shuttle second longitudinal side14 _(S2). The shuttle first longitudinal side 14 _(S1) can be a firstlongitudinal half of the shuttle 14 and the shuttle second longitudinalside 14 _(S2) can be a second longitudinal half of the shuttle 14. Forexample, the shuttle first longitudinal side 14 _(S1) can include halfof the suture holder 18, and the shuttle second longitudinal side 14_(S2) can include the other half of the suture holder 18. The shuttlefirst longitudinal side 14 _(S1) can have zero, one, or multiple malestops 412, and the shuttle second longitudinal side 14 _(S2) can havezero, one, or multiple male stops 412. For example, FIG. 49A illustratesthat the shuttle first longitudinal side 14 _(S1) can have one male stop412 (e.g., the first male stop 412 a) and that the shuttle secondlongitudinal side 14 _(S2) can have one male stop 412 (e.g., the secondmale stop 412 b). FIG. 49A further illustrates that the shuttle 14 canhave a shuttle first terminal end 14 _(TE1) and a shuttle secondterminal end 14 _(TE2). The shuttle first longitudinal side 14 _(S1) canhave the shuttle first terminal end 14 _(TE1) and the shuttle secondlongitudinal side 14 _(S2) can have the shuttle second terminal end 14_(TE2). The shuttle first and second terminal ends 14 _(TE1), 14 _(TE2)can be the terminal tip 165 at each end of the shuttle 14 or any otherpoint of the shuttle 14 or the shuttle tips 164 that is the farthestfrom the longitudinal center of the shuttle 14 (e.g., from the sutureholder 18 as shown in FIG. 49A) as measured along any axis, including,for example, along the shuttle longitudinal axis 14 _(A1). For example,FIG. 49A illustrates that the shuttle first terminal end 14 _(TE1) canbe, for example, the terminal tip 165 of the shuttle first tip 164 a andthat the shuttle second terminal end 14 _(TE2) can be, for example, theterminal tip 165 of the shuttle second tip 164 b.

FIG. 49A further illustrates that the male stops 412 can have a malestop transition region 412 _(TR) between the male stop first and secondterminal ends 412 _(TE1), 412 _(TE2). The male stop transition region412 _(TR) can be straight, curved, or both. The male stop transitionregion 412 _(TR) can be where the male stop 412 changes from one malestop section 412 _(S) to another male stop section 412 _(S). Forexample, FIG. 49A illustrates that the male stop transition region 412_(TR) can be where the male stop 412 changes from the male stop firstsection 412 _(S1) to the male stop second section 412 _(S2). The malestop transition region 412 _(TR) can include one or multiple steps. Forexample, FIG. 49A illustrates that the male stop transition region 412_(TR) can be a single step, such that the narrow proximal endtransitions to the wide distal end with a single step as shown, forexample, so that the male stops 412 have or resemble a hammerhead shape.As another example, the male stop transition region 412 _(TR) can betapered instead of having one or multiple steps, or can be tapered inaddition to having one or multiple steps. The male stop transitionregion 412 _(TR) can be anywhere along the length of the male stops 412,including, for example, closer to the male stop first terminal end 412_(TE1) than to the male stop second terminal end 412 _(TE2), closer tothe male stop second terminal end 412 _(TE2) than to the male stop firstterminal end 412 _(TE1) (e.g., as shown in FIG. 49A), or halfway betweenthe male stop first and second terminal ends 412 _(TE1), 412 _(TE2)(e.g., as measured between the male stop first and second terminal ends412 _(TE1), 412 _(TE2) along the male stop longitudinal axis 412 _(A1)).

FIG. 49A further illustrates that the male surface 414 of the male stops412 can be a surface of the male stop second longitudinal ends 412_(SE), and that the male surface 414 can laterally extend from a firstside of the male stop second longitudinal end 412 _(SE) (e.g., the sidecloser to the shuttle first lateral side 14 _(L1)) to a second side ofthe male stop second longitudinal end 412 _(SE) (e.g., the side closerto the shuttle second lateral side 14 _(L2)). FIG. 49A furtherillustrates that the male surface 414 of the male stops 412 can be asurface of the male stop second section 412 _(S2), and that the malesurface 414 can laterally extend from a first side of the male stopsecond section 412 _(S2) (e.g., the side closer to the shuttle firstlateral side 14 _(L1)) to a second side of the male stop second section412 _(S2) (e.g., the side closer to the shuttle second lateral side 14_(L2)).

The male stops 412 can have one or multiple bends 426 (e.g., one, two,three, four, or more bends 426) along the length of the male stops 412.The male stop first section 412 _(S1) and/or the male stop secondsection 412 _(S2) can each have zero, one, or multiple bends 426. Forexample, FIG. 49A illustrates that the base of the male stop 412 canhave a bend 426. For example, FIG. 49A illustrates that the male stopfirst section 412 _(S1) can have a bend 426. The bend 426 can be, forexample, near the male stop first terminal end 412 _(TE1). For example,FIG. 49A illustrates that the male stops 412 can have one bend 426, andthat the one bend 426 can be at the base of the male stops 412 near themale stop first terminal end 412 _(TE1). The bend 426 can become morebent or less bent when the male stops 412 enter a female stop 416, arein a female stop 416, exit a female stop 416, or any combinationthereof. For example, the male stops 412 can have a first bend when themale stops 412 are in a neutral configuration and a second bend when themale stops 412 are in a deflected configuration, where the first bendcan be greater than or less than the second bend.

FIG. 49A further illustrates that the shuttle 14 can have thearrangement of the male stops 412 as shown, including, for example, thefirst and second male stops 412 a, 412 b. The first male stop 412 a canhave a T-shape and the second male stop 412 b can have a T-shape. Asanother example, the first male stop 412 a can have a different shapethan the second male stop 412 b, or vice versa.

FIG. 49A further illustrates that the first male stop 412 a can have afirst male stop first terminal end 412 a _(TE1), a first male stop firstlongitudinal end 412 a _(FE), a first male stop transition region 412 a_(TR), a first male stop second longitudinal end 412 a _(SE), and afirst male stop second terminal end 412 a _(TE2). The male stop firstterminal end 412 _(TE1) of the first male stop 412 a can be the firstmale stop first terminal end 412 a _(TE1). The male stop firstlongitudinal end 412 _(FE) of the first male stop 412 a can be the firstmale stop first longitudinal end 412 a _(FE). The male stop transitionregion 412 _(TR) of the first male stop 412 a can be the first male stoptransition region 412 a _(TR). The male stop second longitudinal end 412_(SE) of the first male stop 412 a can be the first male stop secondlongitudinal end 412 a _(SE). The male stop second terminal end 412_(TE2) of the first male stop 412 a can be the first male stop secondterminal end 412 a _(TE2).

FIG. 49A further illustrates that the second male stop 412 b can have asecond male stop first terminal end 412 b _(TE1), a second male stopfirst longitudinal end 412 b _(PE), a second male stop transition region412 b _(TR), a second male stop second longitudinal end 412 b _(SE), anda second male stop second terminal end 412 b _(TE2). The male stop firstterminal end 412 _(TE1) of the second male stop 412 b can be the secondmale stop first terminal end 412 b _(TE1). The male stop firstlongitudinal end 412 _(FE) of the second male stop 412 b can be thesecond male stop first longitudinal end 412 b _(FE). The male stoptransition region 412 _(TR) of the second male stop 412 b can be thesecond male stop transition region 412 b _(TR). The male stop secondlongitudinal end 412 _(SE) of the second male stop 412 b can be thesecond male stop second longitudinal end 412 b _(SE). The male stopsecond terminal end 412 _(TE2) of the second male stop 412 b can be thesecond male stop second terminal end 412 b _(TE2).

FIG. 49B illustrates various dimensions that the male stops 412 (e.g.,the first male stop 412 a and/or the second male stop 412 b) can have,including, for example, a male stop first section longitudinal length412 _(S1L), a male stop first section width 412 _(S1W), a male stopfirst section thickness 412 _(S1T), a male stop second section length412 _(S2L), a male stop second section width 412 _(S2W), a male stopsecond section thickness 412 _(S2T), a male stop length 412 _(X), and amale stop thickness 412 _(T).

The male stop first section length 412 _(S1L) can be about 0.0050 in. toabout 0.1250 in., including every 0.0001 in. increment within this range(e.g., 0.0050 in., 0.0225 in., 0.1250 in.). The male stop first sectionlength 412 _(S1L) can be measured along the male stop longitudinal axis412 _(A1). The male stop first section length 412 _(S1L) can bemeasured, for example, from the male stop first section first terminalend 412 _(S1TE1) to the male stop first section second terminal end 412_(S1TE2).

The male stop first section width 412 _(S1W) can be about 0.0030 in. toabout 0.0450 in., including every 0.0001 in. increment within this range(e.g., 0.0030 in., 0.0130 in., 0.0450 in.). The male stop first sectionwidth 412 _(S1W) can be measured along the male stop first transverseaxis 412 _(A2), for example, from a first lateral side of the male stopfirst section 412 _(S1) to a second lateral side of the male stop firstsection 412 _(S1) as shown in FIG. 49A.

The male stop first section thickness 412 _(S1T) can be from about0.0080 in. to about 0.0090 in., or more broadly from about 0.0050 in. toabout 0.0125 in., including every 0.0001 in. increment within theseranges (e.g., 0.0050 in., 0.0085 in., 0.0125 in.). The male stop firstsection thickness 412 _(S1T) can be measured along the male stop secondtransverse axis 412 _(A3). The male stop first section thickness 412_(S1T) can be equal to (e.g., as shown in FIG. 49A), greater than, orless than the shuttle thickness 14 _(T). The male stop first sectionthickness 412 _(S1T) can be equal to (e.g., as shown in FIG. 49A),greater than, or less than the shuttle tip thickness 408.

The male stop second section length 412 _(S2L) can be about 0.0050 in.to about 0.1250 in., including every 0.0001 in. increment within thisrange (e.g., 0.0050 in., 0.0100 in., 0.1250 in.). The male stop secondsection length 412 _(S2L) can be measured along the male stoplongitudinal axis 412 _(A1). The male stop second section length 412_(S2L) can be measured, for example, from the male stop second sectionfirst terminal end 412 _(S2TE1) to the male stop second section secondterminal end 412 _(S2TE2). The male stop second section length 412_(S2L) can be less than (e.g., as shown in FIG. 49A), equal to, orgreater than the male stop first section length 412 _(S1L).

The male stop second section width 412 _(S2W) can be about 0.0120 in. toabout 0.0550 in., including every 0.0001 in. increment within this range(e.g., 0.0120 in., 0.0220 in., 0.0550 in.). The male stop second sectionwidth 412 _(S2W) can be measured along the male stop first transverseaxis 412 _(A2), for example, from a first lateral side of the male stopsecond section 412 _(S2) to a second lateral side of the male stopsecond section 412 _(S2) as shown in FIG. 49A. The male stop secondsection width 412 _(S2W) can be equal to, greater than (e.g., as shownin FIG. 49A), or less than the male stop first section width 412 _(S1W).

The male stop second section thickness 412 _(S2T) can from about 0.0080in. to about 0.0090 in., or more broadly from about 0.0050 in. to about0.0125 in., including every 0.0001 in. increment within these ranges(e.g., 0.0050 in., 0.0085 in., 0.0125 in.). The male stop second sectionthickness 412 _(S2T) can be measured along the male stop secondtransverse axis 412 _(A3). The male stop second section thickness 412_(S2T) can be equal to (e.g., as shown in FIG. 49A), greater than, orless than the shuttle thickness 14 _(T). The male stop second sectionthickness 412 _(S2T) can be equal to (e.g., as shown in FIG. 49A),greater than, or less than the male stop first section thickness 412_(S1T). The male stop second section thickness 412 _(S2T) can be equalto (e.g., as shown in FIG. 49A), greater than, or less than the shuttletip thickness 408.

The male stop length 412 _(X) can be about 0.0150 in. to about 0.2000in., including every 0.0001 in. increment within this range (e.g.,0.0150 in. 0.0325 in., 0.2000 in.). The male stop length 412 _(X) can bemeasured along the male stop longitudinal axis 412 _(A1), and can be,for example, the male stop first section length 412 _(S1L) and the malestop second section length 412 _(S2L) added together.

The male stop thickness 412 _(T) can be from about 0.0080 in. to about0.0090 in., or more broadly from about 0.0050 in. to about 0.0125 in.,including every 0.0001 in. increment within these ranges (e.g., 0.0050in., 0.0085 in., 0.0125 in.). The male stop thickness 412 _(T) can beequal to (e.g., as shown in FIG. 49A), greater than, or less than theshuttle thickness 14 _(T). As shown in FIG. 49B, the male stops 412 canhave a constant or uniform male stop thickness 412 _(T) (e.g., the malestop first section thickness 412 _(S1T) and the male stop second sectionthickness 412 _(S2T) can be equal to each other). As another example,the male stop first section thickness 412 _(S1T) can be less than orgreater than the male stop second section thickness 412 _(S2T), forexample, by about 0.0050 in. to about 0.0150 in., including every 0.0001in. increment within this range (e.g., 0.0050 in., 0.0150 in.).

The first male stop 412 a can have the dimensions and features shown inFIG. 49B.

The second male stop 412 b can have the dimensions and features shown inFIG. 49B.

FIGS. 49A and 49B further illustrate that the male stops 412 (e.g.,their length, width, and/or thickness) can be shorter than the length,width, and/or thickness of the shuttle 14, for example, as measuredalong the shuttle longitudinal axis 14 _(A1) (e.g., for length), alongthe shuttle first transverse axis 14 _(A2) (e.g., for width), and/oralong the shuttle second transverse axis 14 _(A3) (e.g., for thickness).The male stops 412 (e.g., their length, width, and/or thickness) can beshorter than the shuttle width (e.g., shuttle width 292).

FIG. 49C illustrates that he suture 70 can be attached to the shuttle14, for example, to the suture holder 18 via the suture loop 162.

FIG. 49C further illustrates that the male stops 412 can be suturestops, whereby the male stops 412 can be engageable with the suture 70and/or the suture loop 162. When the suture 70 or the suture loop 162 isengaged with a male stop 412, the suture 70 or the suture loop 162 cancontact the male stop 412. When the suture 70 or suture loop 162 is incontact a male stop 412 (e.g., with the first male stop 412 a or withthe second male stop 412 b), movement of the shuttle 14 into the jaw canbe inhibited or prevented. When the suture 70 or suture loop 162 is incontact a male stop 412 (e.g., with the first male stop 412 a or withthe second male stop 412 b), movement of the suture 70 or the sutureloop 162 into the jaw can be inhibited or prevented. The male stops 412can, for example, inhibit or prevent the suture 70 and/or the sutureloop 162 from entering the shuttle track beyond the suture holder slot.In this way, the male stops 412 can advantageously prevent or inhibitthe device 188 from getting jammed with the suture 70 or the suture loop162 by inhibiting or preventing the suture 70 or the suture loop 162from entering in the shuttle track beyond the suture holder slot. Themale stops 412 can thereby be, for example, mono-functional and/orbi-functional male stops, restricting movement of the shuttle 14 whenengaged with the jaws and/or restricting movement of the suture 70and/or the suture loop 162.

FIG. 49A further illustrates that the male stops 412 can, for example,guide and/or limit where the suture 70 or the suture loop 162 can foldover the shuttle first and second lateral sides 14 _(L1), 14 _(L2). Forexample, FIG. 49A illustrates that the shuttle 14 can have a suture zone70 _(Z) defined within suture zone lines 70 _(ZL) (e.g., four suturezone lines 70 _(ZL), for example, the three shown and a fourthobstructed by the first male stop 412 a, where the fourth suture zoneline 70_(ZL can be on the opposite lateral side of the shuttle 14 than the suture zone line 70)_(ZL) that is illustrated next to the first male stop 412 a). If or whenthe suture 70 or the suture loop 162 folds over shuttle first lateralside 14 _(L1) or over the shuttle second lateral side 14 _(L2), the malestops 412 (e.g., the first and second male stops 412 a, 412 b) can guidethe suture 70 or the suture loop 162 to fold or bend onto or above thesuture zone 70 _(Z) and/or can inhibit or prevent the suture 70 or thesuture loop 162 from folding or bending on or above the shuttle 14outside of the suture zone 70 _(Z).

The male stop second longitudinal end 412 _(SE) can be engageable withthe suture 70 and/or the suture loop 162 such that one or multipleportions of the male stop second longitudinal end 412 _(SE) can beengageable with the suture 70 and/or the suture loop 162 (e.g., the malestop first and/or second sections 412 _(S1), 412 _(S2)). For example,the suture 70 and/or the suture loop 162 can be engageable with the malesurface 414, with the male stop second terminal end 412 _(TE2), and/orwith another surface of the male stops 412. For example, FIG. 49Cillustrates that the first male stop 412 a can be a shuttle first suturestop and that the second male stop 412 b can be a shuttle second suturestop.

FIG. 49C further illustrates that the shuttle first transverse axis 14_(A2) can be a center axis that splits the shuttle 14 into two halves(e.g., into the shuttle first and second longitudinal sides 14 _(S1), 14_(S2)). Half of the suture holder 18 can be on a first side of theshuttle first transverse axis 14 _(A2) and that half of the sutureholder 18 can be on a second side of the shuttle first transverse axis14 _(A2). For example, FIG. 49C illustrates that the shuttle firstlongitudinal side 14 _(S1) can include a first half of the suture holder18 and that the shuttle second longitudinal side 14 _(S2) can include asecond half of the suture holder 18.

FIGS. 49A-49C further illustrate that a male stop 412 can be on eachlongitudinal side of the shuttle 14. For example, FIGS. 49A-49Cillustrate that the first male stop 412 a can be on the shuttle firstlongitudinal side 14 _(S1) and the second male stop 412 b can be on theshuttle second longitudinal side 14 _(S2).

FIGS. 49A-49C further illustrate that a male stop 412 can be on eachlateral side of the shuttle 14. The male stops 412 can be on the shuttlefirst and second lateral sides 14 _(L1), 14 _(L2). For example, FIGS.49A-49C illustrate that a first half of the first male stop 412 a (e.g.,a first half of the first male stop first longitudinal end 412 a _(FE)and a first half of the first male stop second longitudinal end 412 a_(SE)) can be on the shuttle first lateral side 14 _(L1) and that asecond half of the first male stop 412 a (e.g., a second half of thefirst male stop first longitudinal end 412 a _(FE) and a second half ofthe first male stop second longitudinal end 412 a _(SE)) can be on theshuttle second lateral side 14 _(L2). FIGS. 49A-49C further illustratethat a first half of the second male stop 412 b (e.g., a first half ofthe second male stop first longitudinal end 412 b _(FE) and a first halfof the second male stop second longitudinal end 412 b _(SE)) can be onthe shuttle first lateral side 14 _(L1) and that a second half of thesecond male stop 412 b (e.g., a second half of the second male stopfirst longitudinal end 412 b _(FE) and a second half of the second malestop second longitudinal end 412 b _(SE)) can be on the shuttle secondlateral side 14 _(L2).

FIGS. 49A-49C further illustrate that the shuttle 14 can have ahammerhead-shaped male stop 412 on each longitudinal side of the shuttle14, for example, one on the shuttle first longitudinal side 14 _(S1) andone on the shuttle second longitudinal side 14 _(S2).

FIGS. 49A-49C further illustrate that the first male stop 412 a can becloser to the shuttle first terminal end 14 _(TE1) than to the shuttlesecond terminal end 14 _(TE2). The first male stop 412 a can be betweena shuttle center (e.g., a shuttle longitudinal midpoint) and the shuttlefirst terminal end 14 _(TE1). The shuttle longitudinal midpoint can behalfway between the shuttle first and second terminal ends 14 _(TE1), 14_(TE2). For example, FIGS. 49A and 49C illustrate that the shuttlelongitudinal midpoint can be halfway across the suture holder 18, andFIG. 49C further illustrates that where the shuttle longitudinal axis 14_(A1) and the shuttle first transverse axis 14 _(A2) are center axes,respectively, the shuttle longitudinal midpoint can be where the shuttlelongitudinal axis 14 _(A1) intersects the shuttle first transverse axis14 _(A2).

FIGS. 49A-49C further illustrate that the second male stop 412 b can becloser to the shuttle second terminal end 14 _(TE2) than to the shuttlefirst terminal end 14 _(TE1). The second male stop 412 b can be betweenthe shuttle center (e.g., the shuttle longitudinal midpoint) and theshuttle second terminal end 14 _(TE2).

FIGS. 49A-49C further illustrate that the first and second male stops412 a, 412 b can each extend toward a midpoint (e.g., the longitudinalcenter) of the shuttle 14, for example, toward the suture holder 18. Asanother example, however, the first and second male stops 412 a, 412 bcan extend away from the center of the shuttle 14. For example, thefirst and second male stops 412 a, 412 b can both extend from the sutureholder 18, with the first and second male stops 412 a, 412 b eachextending away from the suture holder 18. In this example, the first andsecond male stops 412 a, 412 b can be integrated with or integrallyformed with the suture holder 18.

FIGS. 49A-49C further illustrate that the first male stop 412 a canextend toward the second male stop 412 b and that the second male stop412 b can extend toward the first male stop 412 a. As another example,the first and second male stops 412 a, 412 b can extend away from eachother. As another example, the first and second male stops 412 a, 412 bcan extend away from each other and away from a longitudinal center ofthe shuttle (also referred to as the shuttle longitudinal midpoint).

FIG. 49D illustrates that a gap G can be between the male stops 412 andthe shuttle body 160. The width of the gaps G can be constant. The gapsG can have multiple widths. For example, FIG. 49D illustrates that thegaps G can have multiple gap widths G_(W), including, for example, afirst gap width G_(W1) and a second gap width G_(W2). The first gapwidth G_(W1) can be between the male stop first section 412 _(S1) andthe shuttle body 160, for example, as measured along the shuttle firsttransverse axis 14 _(A2) and/or along the male stop first transverseaxis 412 _(A2). The second gap width G_(W2) can be between the male stopsecond section 412 _(S2) and the shuttle body 160, for example, asmeasured along the shuttle first transverse axis 14 _(A2) and/or alongthe male stop first transverse axis 412 _(A2). The first gap widthG_(W1) can be greater than or less than the second gap width G_(W2). Forexample, FIG. 49D illustrates that for a hammerhead shape, the secondgap width G_(W2) can be less than the first gap width G_(W1). As anotherexample, the first gap width G_(W1) can be zero or very small such thatthe male stop first section 412 _(S1) is flush with the shuttle body 160(e.g., so that male stop first section 412 _(S1) can deflect into andout of the holes 404 and/or 405) and the male stop second section 412_(S2) can extend over the shuttle first and/or second lateral sides 14_(L1), 14 _(L2). Where the male stop second section 412 _(S2) extendsover the shuttle first and/or second lateral sides 14 _(L1), 14 _(L2),the male stop second section 412 _(S2) can be engageable with theshuttle body 160, for example, to inhibit or prevent too much deflectionof the male stops 412. The shuttle body 160 can thereby act as a stopfor the male stops 412 and limit the range of motion of the male stops412.

FIG. 49E illustrates that the male stops 412 can be moveable (e.g.,deflectable), for example, toward the shuttle longitudinal axis 14 _(A1)and/or away from the shuttle longitudinal axis 14 _(A1). The male stops412 can move (e.g., deflect), for example, by bending (e.g., linearbending), twisting, or both. For example, the male stops 412 can bemoveable away from the shuttle longitudinal axis 14 _(A1) in a male stopfirst direction 412 _(FD) and/or can be moveable toward the shuttlelongitudinal axis 14 _(A1) in a male stop second direction 412 _(SD).The male stop first direction 412 _(FD) can be, for example, a rotationand/or a translation of the male stop 412 toward the shuttlelongitudinal axis 14 _(A1). The male stop second direction 412 _(SD) canbe, for example, a rotation and/or a translation of the male stop 412away from the shuttle longitudinal axis 14 _(A1). For example, FIG. 49Eillustrates in the orientation shown that the male stop first direction412 _(FD) for the first male stop 412 a can be a clockwise rotation,that the male stop first direction 412 _(FD) for the second male stop412 b can be a counterclockwise rotation, that the male stop seconddirection 412 _(SD) for the first male stop 412 a can be acounterclockwise rotation, and that the male stop second direction 412_(SD) for the second male stop 412 b can be a clockwise rotation.

When the male stops 412 move in the male stop first and/or seconddirections 412 _(FD), 412 _(SD), the male stops 412 can pivot abouttheir base (e.g., about the male stop first terminal ends 412 _(TE1)),can bend along their length, or both. The male stop first terminal ends412 _(TE1) can be the fulcrum around which the male stops 412 rotatewhen the male stops 412 are moved (e.g., deflected) from a neutralconfiguration to a deflected configuration and vice versa. When the malestops 412 are deflected by a female stop 416, the male stops 412 canbend distal to the fulcrum (e.g., the bend 426) when the male stop 412pivots about the fulcrum. When the male stops 412 are deflected by afemale stop 416, the male stops 412 can be rigid and not bend distal tothe fulcrum (e.g., the bend 426) when the male stop 412 pivots about thefulcrum.

FIG. 49E further illustrates that the male stops 412 (e.g., the firstand second male stops 412 a, 412 b) can be moveable (e.g., deflectable)back and forth between a male stop first configuration and a male stopsecond configuration. The male stop first configuration can be the malestop neutral configuration (also referred to as the male stopnon-deflected configuration). The male stop neutral configuration can bethe configuration of the male stops 412 shown, for example, in FIGS.49A-49E. The male stops 412 can have the male stop first configuration(e.g., neutral configuration), for example, when the male stop 412 isnot engaged with a female stop 416, when the male stop 412 is fullyengaged with a female stop 416, or both. The male stop secondconfiguration can be a male stop deflected configuration in which themale stop 412 is in a configuration different from the male stop neutralconfiguration. For example, the male stop second configuration can be adeflected configuration in which the male stop 412 (e.g., the male stopfirst section 412 _(S1) and/or the male stop second section 412 _(S2))is closer to the shuttle longitudinal axis 14 _(A1) than when the malestop 412 is in the male stop first configuration. As another example,the male stop second configuration can be a deflected configuration inwhich the male stop 412 (e.g., the male stop first section 412 _(S1)and/or the male stop second section 412 _(S2)) is farther from theshuttle longitudinal axis 14 _(A1) than when the male stop 412 is in themale stop first configuration. The male stops 412 can have the male stopsecond configuration (e.g., deflected configuration), for example, whenthe male stop 412 partially engaged with a female stop 416, when themale stop 412 is fully engaged with a female stop 416, or both.

FIG. 49E further illustrates the arrangement of features shown, forexample, with exemplary dimensions D₁-D₇, the shuttle thickness 14 _(T),and the shuttle tip thickness 408.

The dimension D₁ can be the distance between the terminal ends 165 ofthe first and second shuttle tips 164 a, 164 b. For example, thedimension D₁ can be the shortest distance between the terminal ends 165of the first and second shuttle tips 164 a, 164 b (e.g., as measuredalong a straight line). The dimension D₁ can be, for example, 0.150 in.to about 0.500 in., including every 0.001 in. increment within thisrange (e.g., 0.257 in.).

The dimension D₂ can be the angle between the shuttle first and secondtips 164 a, 164 b. The dimension D₂ can be, for example, 60 degrees toabout 85 degrees, or more narrowly from about 70 degrees to about 80degrees, including every 1 degree increment within these ranges (e.g.,70 degrees, 75 degrees, 80 degrees).

The dimension D₃ can be the radius of curvature of the shuttle 14. Thedimension D₃ can be the radius of curvature of the shuttle body 160, theshuttle first tip 164 a, and/or the shuttle second tip 164 b. Forexample, FIG. 49E illustrates that the dimension D₃ can be the radius ofcurvature of the shuttle body 160 between the shuttle first and secondtips 164 a, 164 b, and that the shuttle first and second tips 164 a, 164b can be straight. The dimension D₃ can be, for example, for example,0.075 in. to about 0.300 in., including every 0.001 in. increment withinthis range (e.g., 0.118 in.). A shuttle 14 with two straight sections(e.g., the shuttle first and second tips 164 a, 164 b) and a curvedsection in between (e.g., the shuttle body 160 between the shuttle firstand second tips 164 a, 164 b) can advantageously flex the shuttle 14when the shuttle 14 is in the jaw tracks. This can advantageously keepthe shuttle 14 engaged with the jaw tracks and inhibit or prevent theshuttle from floating in the jaw tracks. The straight sections (e.g.,the shuttle tips 164) can cause the shuttle 14 to flex when in a jawtrack such that the dimension D₃ is less when the shuttle 14 is in a jawtrack than when the shuttle 14 is not in a jaw track. For example, thedimension D₃ can be about 0.010 in. to about 0.075 in. less when theshuttle 14 is in a jaw track, including every 0.001 in. increment withinthis range (e.g., 0.015 in.). In addition to or in lieu of the twostraight sections, the radius of curvature of the jaw tracks can be lessthan the dimension D₃ when the shuttle 14 is in a neutral positionoutside of the jaws. The radius of curvature of the jaw tracks can be,for example, about 0.010 in. to about 0.075 in., including every 0.001in. increment within this range (e.g., 0.015 in.). The shuttle 14 canthereby be a spring when in the jaw track, being biased to push the malestops 412 radially outward into the female stops 416 when the shuttle 14is moved (e.g., translated) into them.

The dimension D₄ can be the height between the shuttle tips 164 and theapex of the shuttle body 160. The dimension D₄ can be, for example,0.050 in. to about 1.350 in., including every 0.001 in. increment withinthis range (e.g., 0.092 in.).

The dimension D₅ can be the height between the shuttle tips 164 and theapex of the male stops 412. The dimension D₅ can be, for example, 0.050in. to about 1.350 in., including every 0.001 in. increment within thisrange (e.g., 0.095 in.).

The dimension D₆ can be the height between the bottom of the shuttle 14and the apex of the male stops 412. The dimension D₆ can be, forexample, 0.0175 in. to about 0.0205 in., or more broadly from about0.0100 in. to about 0.1250 in., including every 0.0001 in. incrementwithin these ranges (e.g., 0.0190 in.).

The dimension D₇ can be the length of a masked area MA as measured, forexample, from the terminal tips 165 of the shuttle tips 164 as shown.The dimension D₇ can be, for example, 0.055 in. to about 0.095 in.,including every 0.001 in. increment within this range (e.g., 0.075 in.).A coating or a finish can be applied to the masked area, for example,around the perimeter of the shuttle 14 in the masked area MA.

FIG. 49E further illustrates that the shuttle tip thickness 408 and theshuttle thickness 14 _(T) can be the same, for example, from about0.0080 in. to about 0.0090 in., or more broadly from about 0.0050 in. toabout 0.0125 in., including every 0.0001 in. increment within theseranges (e.g., 0.0050 in., 0.0085 in., 0.0125 in.).

FIG. 49F illustrates that the shuttle 14 can have a straightconfiguration (also referred to as a flat configuration). When theshuttle 14 is in the straight configuration, the shuttle longitudinalaxis 14 _(A1) can be straight. The straight configuration can be anon-shape set configuration or a pre-shape set configuration. A shuttle14 in a flat configuration can be shape set to have a non-flat shape(e.g., a shape with a curve). For example, the shuttle 14 illustrated inFIG. 49F can be shape set to have the shape shown in FIGS. 49A-49E.FIGS. 49A-49F thereby illustrate that the shuttle 14 can have a flatconfiguration and a non-flat configuration, whereby the shuttle 14 canbe shape set from the flat configuration to have the non-flatconfiguration.

FIG. 49F further illustrates the arrangement of features shown, forexample, with exemplary dimensions D₈-D₁₆, the male stop first sectionlength 412 _(S1L), the male stop first section width 412 _(S1W), themale stop second section length 412 _(S2L), the male stop second sectionwidth 412 _(S2W), the male stop length 412 _(X), and the shuttle width292.

The dimension D₈ can be the length of the suture holder 18 which can be,for example, from about 0.0050 in. to about 0.0200 in., including every0.0001 in. increment within this range (e.g., 0.0050 in., 0.0110 in.,0.0200 in.).

The dimension D₉ can be the width of the holes 404 and/or 405 that themale stops 412 are in, extend over, and/or extend into, for example,from the shuttle body 160. The dimension D₉ can be, for example, fromabout 0.0110 in. to about 0.540 in., including every 0.0001 in.increment within this range (e.g., 0.0110 in., 0.0260 in., 0.0540 in.).The male stops 412 can extend into and/or over from the shuttle body 160from any point around the holes 404 and/or 405. For example, FIG. 49Fillustrates that the male stops 412 can extend toward the suture holder18 from longitudinal ends of the holes 404 and/or 405.

The dimension D₁₀ can be the length of the holes 404 and/or 405 betweenthe suture holder 18 and the male stops 412. The dimension D₁₀ can be,for example, from about 0.0150 in. to about 0.0410 in., including every0.0001 in. increment within this range (e.g., 0.0150 in., 0.0280 in.,0.0410 in.).

The dimension D₁₁ can be the length of the shuttle 14 which can be, forexample, from about 0.200 in. to about 0.400 in., including every 0.001in. increment within this range (e.g., 0.200 in., 0.317 in., 0.400 in.).

The dimension D₁₂ can be the radius of curvature of the shuttle body 160and of the holes 404 and/or 405 at the position shown, and can be, forexample, from about 0.007 in. to about 0.019 in., including every 0.001in. increment within this range (e.g., 0.007 in., 0.012 in., 0.019 in.).

The dimension D₁₃ can be the radius of curvature of the male stoptransition region 412 _(TR) at the position shown, and can be, forexample, from about 0.001 in. to about 0.005 in., including every 0.001in. increment within this range (e.g., 0.001 in., 0.002 in., 0.007 in.).

The dimension D₁₄ can be the radius of curvature of the shuttle body 160and of the holes 404 and/or 405 at the position shown, and can be, forexample, from about 0.002 in. to about 0.008 in., including every 0.001in. increment within this range (e.g., 0.002 in., 0.005 in., 0.008 in.).

The dimension D₁₅ can be the radius of curvature of the shuttle body 160and of the holes 404 and/or 405 at the position shown, and can be, forexample, from about 0.001 in. to about 0.005 in., including every 0.001in. increment within this range (e.g., 0.001 in., 0.002 in., 0.005 in.).

The dimension D₁₆ can be the angle of the shuttle tips 164 (e.g., theshuttle first and second tips 164 a, 164 b). The dimension D₁₆ can be,for example, the angle between the first and second tip surfaces 406 a,406 b of the shuttle tips 164. The dimension D₁₆ can be, for example, 25degrees to about 85 degrees, or more narrowly from about 45 degrees toabout 75 degrees, including every 1 degree increment within these ranges(e.g., 25 degrees, 45 degrees, 60 degrees, 75 degrees, 85 degrees).

FIG. 49F further illustrates that the shuttle 14, the male stops 412,and the shuttle tips 164 can be a monolithic piece of material.

FIG. 49G illustrates that the shuttle longitudinal axis 14 _(A1) can bestraight when the shuttle is in a straight configuration.

FIGS. 49A-49G illustrate the features and dimensions shown, and that theshuttle 14 can have these features and dimensions, for example, in theconfigurations shown. As another example, the shuttle 14 can have thefeatures and dimensions shown in FIGS. 49A-49G when the shuttle 14 is ina jaw track.

FIG. 49H ₁ illustrates that when the shuttle 14 is moved (e.g.,translated, slid) in the upper jaw shuttle track 64 as shown by arrow602, one or multiple male stops 412 can move (e.g., deflect) into afemale stop 416, for example, by moving past (e.g., under) the lip 420.For example, FIG. 49H ₁ illustrates that when the shuttle 14 is movedinto the upper jaw shuttle track 64, a male stop 412 (e.g., the secondmale stop 412 b) can move into and/or engage with a female stop 416(e.g., with the second female stop 416 b), for example, by moving (e.g.,deflecting) under the lip 420. FIG. 49H ₁ further illustrates that whenthe shuttle 14 is moved (e.g., translated, slid) out of the upper jawshuttle track 64 as shown by arrow 604, one or multiple male stops 412can move (e.g., deflect) out of a female stop 416, for example, bymoving past (e.g., under) the lip 420. For example, FIG. 49H ₁illustrates that when the shuttle 14 is moved out of the upper jawshuttle track 64, a male stop 412 (e.g., the second male stop 412 b) canmove under the lip 420 and disengage with a female stop 416 (e.g., withthe second female stop 416 b). Half of the upper jaw is showntransparent in FIG. 49H ₁ so that the shuttle 14 can be more easily seenin the upper jaw 30, and so that the engagement between the male andfemale stops 412, 416 can be more easily seen.

When the second male stop 412 b is between the lip 420 and the upper jawpusher 86, the second male stop 412 b can be engaged with the secondfemale stop 416 b. When the second male stop 412 b is engaged with thesecond female stop 416 b, the second male stop 412 b can be in contactwith the second female stop 416 b. For example, when the second malestop 412 b is engaged with the second female stop 416 b, the malesurface 414 can be in contact with the female surface 418. As anotherexample, when the second male stop 412 b is engaged with the secondfemale stop 416 b, the second male stop 412 b may not be in contact withthe second female stop 416 b. For example, when the second male stop 412b is engaged with the second female stop 416 b, the male surface 414 maynot be in contact with the female surface 418 such that the second malestop 412 b can float in the second female stop 416 b. When the secondmale stop 412 b is engaged with the second female stop 416 b, the secondmale stop 412 b can have a male stop first configuration or a male stopsecond configuration. The male stop first configuration can be a malestop neutral configuration (e.g., the configuration of the second malestop 412 b shown in FIGS. 49A-49E). The male stop second configurationcan be a male stop deflected configuration.

When the second male stop 412 b is engaged with the lip 420, forexample, as the shuttle 14 is moving into or out of the second femalestop 416 b, the second male stop 412 b can have the male stop secondconfiguration or a male stop third configuration. The male stop thirdconfiguration can be a male stop deflected configuration. When thesecond male stop 412 b is in the male stop third configuration, thesecond male stop 412 b can be more deflected than when in the male stopsecond configuration.

When the second male stop 412 b is in the upper jaw 30 and before thesecond male stop 412 b is in contact with the lip 420, the second malestop 412 b can have the male stop first configuration.

When the second male stop 412 b has the male stop first, second, orthird configuration, the first male stop 412 a can have the male stopfirst configuration. As another example, the male stop firstconfiguration of the second male stop 412 b can be a second male stopfirst configuration, the male stop second configuration of the secondmale stop 412 b can be a second male stop second configuration, the malestop third configuration of the second male stop 412 b can be a secondmale stop third configuration, the male stop first configuration of thefirst male stop 412 a can be a first male stop first configuration, themale stop second configuration of the first male stop 412 a can be afirst male stop second configuration, and the male stop thirdconfiguration of the first male stop 412 a can be a first male stopthird configuration. The first male stop first configuration can be, forexample, the same or different neutral configuration as the second malestop first configuration. The first male stop second configuration canbe, for example, the same or different amount of deflection as thesecond male stop second configuration. The first male stop thirdconfiguration can be, for example, the same or different amount ofdeflection as the second male stop third configuration.

The female stops 416 can be flexible and/or rigid. For example, thefemale stops 416 can have the same configuration when the male stops 412are in the male stop first, second, and/or third configurations. Asanother example, the female stops 416 can have a female stop firstconfiguration (also referred to as a female stop neutral configurationor a female stop non-deflected configuration) when the male stops 412are not engaged with the female stops 416, and can have a female stopsecond configuration (also referred to as a female stop deflectedconfiguration) when the male stops 412 are engaged with the female stops416.

The male stops 412 can be springs biased to have the male stop firstconfiguration. For example, when the second male stop 412 b is in themale stop second configuration, the second male stop 412 b can be biasedto return (e.g., passively return) to the male stop first configuration.For example, when the second male stop 412 b is in the male stop secondconfiguration, the second male stop 412 b can be biased to rebound orspring back to the male stop first configuration. This canadvantageously allow the second male stop 412 b to passively engage withthe second female stop 416 b as the second male stop 412 b is moved intothe upper jaw 30, past the lip 420, and into the second female stop 416b.

FIG. 49H ₂ illustrates that when the shuttle 14 is moved (e.g.,translated, slid) in the lower jaw shuttle track 66 as shown by arrow604, one or multiple male stops 412 can move (e.g., deflect) into afemale stop 416, for example, by moving past (e.g., under) the lip 420.For example, FIG. 49H ₂ illustrates that when the shuttle 14 is movedinto the lower jaw shuttle track 66, a male stop 412 (e.g., the firstmale stop 412 a) can move into and/or engage with a female stop 416(e.g., with the first female stop 416 a), for example, by moving (e.g.,deflecting) under the lip 420. FIG. 49H ₂ further illustrates that whenthe shuttle 14 is moved (e.g., translated, slid) out of the lower jawshuttle track 66 as shown by arrow 602, one or multiple male stops 412can move (e.g., deflect) out of a female stop 416, for example, bymoving past (e.g., under) the lip 420. For example, FIG. 49H ₂illustrates that when the shuttle 14 is moved out of the lower jawshuttle track 66, a male stop 412 (e.g., the first male stop 412 a) canmove under the lip 420 and disengage with a female stop 416 (e.g., withthe first female stop 416 a). Half of the lower jaw is shown transparentin FIG. 49H ₂ so that the shuttle 14 can be more easily seen in thelower jaw 38, and so that the engagement between the male and femalestops 412, 416 can be more easily seen.

When the first male stop 412 a is between the lip 420 and the lower jawpusher 76, the first male stop 412 a can be engaged with the firstfemale stop 416 a. When the first male stop 412 a is engaged with thefirst female stop 416 a, the first male stop 412 a can be in contactwith the first female stop 416 a. For example, when the first male stop412 a is engaged with the first female stop 416 a, the male surface 414can be in contact with the female surface 418. As another example, whenthe first male stop 412 a is engaged with the first female stop 416 a,the first male stop 412 a may not be in contact with the first femalestop 416 a. For example, when the first male stop 412 a is engaged withthe first female stop 416 a, the male surface 414 may not be in contactwith the female surface 418 such that the first male stop 412 a canfloat in the first female stop 416 a. When the first male stop 412 a isengaged with the first female stop 416 a, the first male stop 412 a canhave a male stop first configuration or a male stop secondconfiguration. The male stop first configuration can be a male stopneutral configuration (e.g., the configuration of the first male stop412 a shown in FIGS. 49A-49E). The male stop second configuration can bea male stop deflected configuration.

When the first male stop 412 a is engaged with the lip 420, for example,as the shuttle 14 is moving into or out of the second female stop 416 b,the first male stop 412 a can have the male stop second configuration ora male stop third configuration. The male stop third configuration canbe a male stop deflected configuration. When the first male stop 412 ais in the male stop third configuration, the first male stop 412 a canbe more deflected than when in the male stop second configuration.

When the first male stop 412 a is in the lower jaw 38 and before thefirst male stop 412 a is in contact with the lip 420, the first malestop 412 a can have the male stop first configuration.

The male stops 412 can be springs biased to have the male stop firstconfiguration. For example, when the first male stop 412 a is in themale stop second configuration, the first male stop 412 a can be biasedto return (e.g., passively return) to the male stop first configuration.For example, when the first male stop 412 a is in the male stop secondconfiguration, the first male stop 412 a can be biased to rebound orspring back to the male stop first configuration. This canadvantageously allow the first male stop 412 a to passively engage withthe first female stop 416 a as the second male stop 412 b is moved intothe lower jaw 38, past the lip 420, and into the first female stop 416a.

FIG. 49H ₃ illustrates that when the second male stop 412 b is engagedwith the second female stop 416 b, the male surface 414 of the secondmale stop 412 b can be in contact with the female surface 418. When themale surface 414 is in contact with the female surface 418 of the secondfemale stop 416 b, the second male stop 412 b can have, for example, thesecond male stop first configuration (e.g., a non-deflectedconfiguration) or the second male stop second configuration (e.g., apartially deflected configuration).

FIG. 49H ₃ further illustrates that when the second male stop 412 b isengaged with the second female stop 416 b, the suture loop 162 can beengaged with the first suture stop 534 a. FIG. 49H ₃ further illustratesthat that the outer surface 419 can be a surface of the first suturestop 534 a.

FIG. 49H ₃ further illustrates that when the second male stop 412 b isengaged with the second female stop 416 b, tissue can be moveable (e.g.,pushable) by the second male stop 412 b out of the second female stop416 b, away from the second female stop 416 b, or out of and away fromthe second female stop 416 b. The second male stop 412 b can thereby bea tissue mover that can advantageously keep the second female stop 416 bclear of tissue (or can minimize the amount of tissue in it) that could,for example, otherwise cause the shuttle 14 to get jammed in the upperjaw 30. The first suture stop 534 a, the outer surface 419, and/or thelip 420 can be a tissue barrier, inhibiting or preventing tissue fromentering the second female stop 416 b. The deflection of the second malestop 412 b toward the shuttle longitudinal axis 14 _(A1) as the secondmale stop 412 b passes by (e.g., under) the lip 420 can advantageouslyforce tissue away from the second female stop 416 b, for example, bysqueezing tissue that may be in the holes 404 and/or 405 progressivelytoward the suture holder 18 as the second male stop 412 b isprogressively pinched closer to the shuttle longitudinal axis 14 _(A1)by the lip 420 as the second male stop 412 b is moved into the secondfemale stop 416 b. The second male stop 412 b can clear tissue from thesecond female stop 416 b, can inhibit or prevent tissue from enteringthe second female stop 416 b, or can do any combination thereof.

FIG. 49H ₃ further illustrates that the outer surface 419, the lip 420,and/or the first shuttle stop 534 a can be engageable with the firstmale stop 412 a to inhibit or prevent overextension of the shuttle 14into the upper jaw 30. For example, the outer surface 419, the lip 420,and/or the first shuttle stop 534 a can cause the first male stop 412 ato move in the male stop second direction 412 _(SD) when the first malestop 412 a makes contact with the outer surface 419, the lip 420, and/orthe first shuttle stop 534 a. This can advantageously inhibit or preventthe first male stop 412 a from moving past (e.g., under) the lip 420 inthe upper jaw 30.

FIG. 49H ₄ illustrates that when the first male stop 412 a is engagedwith the first female stop 416 a, the male surface 414 of the first malestop 412 a can be in contact with the female surface 418 of the firstfemale stop 416 a. When the male surface 414 is in contact with thefemale surface 418, the first male stop 412 a can have, for example, thesecond male stop first configuration (e.g., a non-deflectedconfiguration) or the second male stop second configuration (e.g., apartially deflected configuration).

FIG. 49H ₄ further illustrates that when the first male stop 412 a isengaged with the first female stop 416 a, the suture loop 162 can beengaged with the first suture stop 534 a. FIG. 49H ₄ further illustratesthat that the outer surface 419 can be a surface of the first suturestop 534 a.

FIG. 49H ₄ further illustrates that when the first male stop 412 a isengaged with the first female stop 416 a, tissue can be moveable (e.g.,pushable) by the first male stop 412 a out of the first female stop 416a, away from the first female stop 416 a, or out of and away from thefirst female stop 416 a. The first male stop 412 a can thereby be atissue mover that can advantageously keep the first female stop 416 aclear of tissue (or can minimize the amount of tissue in it) that could,for example, otherwise cause the shuttle 14 to get jammed in the lowerjaw 38. The first suture stop 534 a, the outer surface 419, and/or thelip 420 can be a tissue barrier, inhibiting or preventing tissue fromentering the first female stop 416 a. The deflection of the first malestop 412 a toward the shuttle longitudinal axis 14 _(A1) as the firstmale stop 412 a passes by (e.g., under) the lip 420 can advantageouslyforce tissue away from the first female stop 416 a, for example, bysqueezing tissue that may be in the holes 404 and/or 405 progressivelytoward the suture holder 18 as the first male stop 412 a isprogressively pinched closer to the shuttle longitudinal axis 14 _(A1)by the lip 420 as the first male stop 412 a is moved into the firstfemale stop 416 a. The first male stop 412 a can clear tissue from thefirst female stop 416 a, can inhibit or prevent tissue from entering thefirst female stop 416 a, or can do any combination thereof.

FIG. 49H ₄ further illustrates that the outer surface 419, the lip 420,and/or the first shuttle stop 534 a can be engageable with the firstmale stop 412 a to inhibit or prevent overextension of the shuttle 14into the lower jaw 38. For example, the outer surface 419, the lip 420,and/or the first shuttle stop 534 a can cause the first male stop 412 ato move in the male stop second direction 412 _(SD) when the first malestop 412 a makes contact with the outer surface 419, the lip 420, and/orthe first shuttle stop 534 a. This can advantageously inhibit or preventthe first male stop 412 a from moving past (e.g., under) the lip 420 inthe lower jaw 38.

FIGS. 49H ₁ and 49H₃ further illustrate that when the shuttle 14 is inthe upper jaw 30, the first male stop 412 a and the second male stop 412b can be in the upper jaw 30. For example, when the shuttle 14 is in theupper jaw 30, the first and second male stops 412 a, 412 b can bemoveable (e.g., translatable, slideable) in the upper jaw shuttle track64, in the upper jaw suture slot 238 b, or in both. FIGS. 49H ₁ and 49H₃further illustrate that when the shuttle 14 is in the upper jaw 30 andthe second male stop 412 b is in the second female stop 416 b, the firstmale stop 412 a can be in the upper jaw shuttle track 64, in the upperjaw suture slot 238 b, or in both. FIGS. 49H ₁ and 49H₃ furtherillustrate that when the shuttle 14 is in the upper jaw 30, the secondmale stop 412 b can be farther along the upper jaw track 64 than thefirst male stop 412 a. FIGS. 49H ₁ and 49H₃ further illustrate that whenthe second male stop 412 b has the second male stop first, second, orthird configuration, the first male stop 412 a can have the first malestop first configuration. For example, FIGS. 49H ₁ and 49H₃ illustratethat when the shuttle 14 is in the upper jaw 30 and the second male stop412 b is in a deflected configuration or in a non-deflectedconfiguration, the first male stop 412 a can be in a non-deflectedconfiguration.

FIGS. 49H ₂ and 49H₄ further illustrate that when the shuttle 14 is inthe lower jaw 38, the first male stop 412 a and the second male stop 412b can be in the lower jaw 38. For example, when the shuttle 14 is in thelower jaw 38, the first and second male stops 412 a, 412 b can bemoveable (e.g., translatable, slideable) in the lower jaw shuttle track66, in the lower jaw suture slot 238 a, or in both. FIGS. 49H ₂ and 49H₄further illustrate that when the shuttle 14 is in the lower jaw 38 andthe first male stop 412 a is in the first female stop 416 a, the secondmale stop 412 b can be in the lower jaw shuttle track 66, in the lowerjaw suture slot 238 a, or in both. FIGS. 49H ₂ and 49H₄ furtherillustrate that when the shuttle 14 is in the lower jaw 38, the firstmale stop 412 a can be farther along the lower jaw track 66 than thesecond male stop 412 b. FIGS. 49H ₂ and 49H₄ further illustrate thatwhen the first male stop 412 a has the first male stop first, second, orthird configuration, the second male stop 412 b can have the second malestop first configuration. For example, FIGS. 49H ₂ and 49H₄ illustratethat when the shuttle 14 is in the lower jaw 38 and the first male stop412 a is in a deflected configuration or in a non-deflectedconfiguration, the second male stop 412 b can be in a non-deflectedconfiguration.

FIGS. 49H ₁-49H₄ further illustrate that the distance between the firstand second male stops 412 a, 412 b (also referred to as the inter-malestop distance) can be constant, for example, as measured along theshuttle longitudinal axis 14 _(A1). The inter-male stop distance can bemeasured, for example, between the male stop first terminal end 412_(TE1) of the first male stop 412 a and the male stop first terminal end412 _(TE1) of the second male stop 412 b, for example, along the shuttlelongitudinal axis 14 _(A1). The inter-male stop distance can be the samewhen the shuttle 14 is in the upper jaw 30 and when the shuttle 14 is inthe lower jaw 38. For example, the inter-male stop distance can be thesame when the shuttle 14 is in the upper jaw 30 and the second male stop412 b is in the second female stop 416 b as when the shuttle 14 is inthe lower jaw 38 and the first male stop 412 a is in the first femalestop 416 a.

As another example, the inter-male stop distance can be measured, forexample, between the male stop second terminal end 412 _(TE2) of thefirst male stop 412 a and the male stop second terminal end 412 _(TE2)of the second male stop 412 b, for example, along an axis parallel tothe shuttle longitudinal axis 14 _(A1) or along a straight measurementaxis between the two male stop second terminal ends 412 _(TE2). Forexample, when the shuttle 14 is in the upper jaw 30 and the second malestop 412 b is in a deflected configuration and the first male stop 412 ais in a non-deflected configuration, the inter-male stop distance can bea first distance, and when the shuttle 14 is in the upper jaw 30 and thesecond male stop 412 b is in a non-deflected configuration and the firstmale stop 412 a is in a non-deflected configuration, the inter-male stopdistance can be a second distance, where the first distance can be lessthan the second distance. As another example, the first distance can bethe same as the second distance or greater than the second distance.When the shuttle 14 is in the lower jaw 38 and the first male stop 412 ais in a deflected configuration and the second male stop 412 b is in anon-deflected configuration, the inter-male stop distance can be thefirst distance, and when the shuttle 14 is in the lower jaw 38 and thefirst male stop 412 a is in a non-deflected configuration and the secondmale stop 412 b is in a non-deflected configuration, the inter-male stopdistance can be the second distance, where the first distance can beless than the second distance. As another example, the first distancecan be the same as the second distance or greater than the seconddistance.

FIGS. 49H ₁-49H₄ illustrate that the male stops 412 can be passivelyretained in the female stops 416. FIGS. 49H ₁-49H₄ illustrate that whenthe first male stop 412 a is engaged with the first female stop 416 a,the shuttle 14 can be passively retained in the lower jaw 38, and thatwhen the second male stop 412 b is engaged with the second female stop416 b, the shuttle 14 can be passively retained in the upper jaw 30.Movement of the shuttle 14, for example, via the lower and upper pushers76, 86, can engage and disengage the male and female stops 412, 416 fromeach other. For example, for engagement, the lower jaw pusher 76 canmove the second male stop 412 b into the second female stop 416 b toengage the second male stop 412 b with the second female stop 416 b, andthe upper jaw pusher 86 can move the first male stop 412 a into thefirst female stop 416 a to engage the first male stop 412 a with thefirst female stop 416 a. As another example, for disengagement, thelower jaw pusher 76 can move the first male stop 412 a out of the firstfemale stop 416 a to disengage the first male stop 412 a with the firstfemale stop 416 a, and the upper jaw pusher 86 can move the second malestop 412 b out of the second female stop 416 b to disengage the secondmale stop 412 b with the second female stop 416 b. The male stops 412and the female stops 416 can thereby be passive stops, where movement ofthe shuttle 14 cases the male stops 412 to engage and disengage with thefemale stops 416. In this way, the lower jaw pusher 76 can move theshuttle 14 (e.g., the second male stop 412 b) into engagement with thesecond female stop 416 b, the upper jaw pusher 86 can move the shuttle14 (e.g., the second male stop 412 b) out of engagement with the secondfemale stop 416 b, the upper jaw pusher 86 can move the shuttle 14(e.g., the first male stop 412 a) into engagement with the first femalestop 416 a, and the lower jaw pusher 76 can move the shuttle 14 (e.g.,the first male stop 412 a) out of engagement with the first female stop416 a.

When the lower jaw pusher 76 moves the shuttle 14 (e.g., the second malestop 412 b) into engagement with the second female stop 416 b, thesecond male stop 412 b can be deflected from the male stop firstconfiguration to the male stop second configuration, for example, by thelip 420, and the second male stop 412 b can rebound from the male stopsecond configuration back to the male stop first or third configuration,for example, once the second male stop 412 b is moved into the secondfemale stop 416 b.

When the upper jaw pusher 86 moves the shuttle 14 (e.g., the second malestop 412 b) out of engagement with the second female stop 416 b, thesecond male stop 412 b can be deflected from the male stop first orthird configuration to the male stop second configuration, for example,by the lip 420, and the second male stop 412 b can rebound from the malestop second configuration back to the male stop first configuration, forexample, once the second male stop 412 b is moved out of the firstfemale stop 416 a and past the lip 420.

When the upper jaw pusher 86 moves the shuttle 14 (e.g., the first malestop 412 a) into engagement with the first female stop 416 a, the firstmale stop 412 a can be deflected from the male stop first configurationto the male stop second configuration, for example, by the lip 420, andthe first male stop 412 a can rebound from the male stop secondconfiguration back to the male stop first or third configuration, forexample, once the first male stop 412 a is moved into the first femalestop 416 a.

When the lower jaw pusher 76 moves the shuttle 14 (e.g., the first malestop 412 a) out of engagement with the first female stop 416 a, thefirst male stop 412 a can be deflected from the male stop first or thirdconfiguration to the male stop second configuration, for example, by thelip 420, and the first male stop 412 a can rebound from the male stopsecond configuration back to the male stop first configuration, forexample, once the first male stop 412 a is moved out of the first femalestop 416 a and past the lip 420.

When the male stops 412 are engaged with a female stop 416, one or bothof the lower jaw pusher 76 and the upper jaw pusher 86 may or may not bein contact with the male stops 412. For example, FIGS. 49H ₁ and 49H₃illustrate that after the second male stop 412 b is moved intoengagement with the second female stop 416 b, the lower jaw pusher 76can be moved (e.g., retracted, withdrawn) into the lower jaw 38 and agap can be between the second male stop 412 b before the upper jawpusher 86 is moved into engagement with the shuttle 14 to move theshuttle 14 from the upper jaw 30 into the lower jaw 38. As anotherexample, FIGS. 49H ₂ and 49H₄ illustrate that after the first male stop412 a is moved into engagement with the first female stop 416 a, theupper jaw pusher 86 can be moved (e.g., retracted, withdrawn) into theupper jaw 30 and a gap can be between the first male stop 412 a beforethe lower jaw pusher 76 is moved into engagement with the shuttle 14 tomove the shuttle 14 from the lower jaw 38 into the upper jaw 30.

FIGS. 49H ₁-49H₄ further illustrate that the female stops 416 (e.g., thefirst female stop 416 a and the second female stop 416 b) can be radialfemale stops in which the female stop extends radially away from shuttletrack (e.g., radially away from shuttle tracks 64 and 66).

FIG. 50A illustrates that the shuttle 14 can have one or multiple malestops 412 that extend laterally away from the shuttle longitudinal axis14 _(A1). The shuttle 14 can have 1-8 or more male stops 412 that extendlaterally away from the shuttle longitudinal axis 14 _(A1), includingevery one increment within this range (e.g., 1 male stop that extendslaterally away from the shuttle longitudinal axis 14 _(A1), 2 male stopsthat extend laterally away from the shuttle longitudinal axis 14 _(A1),8 male stops that extend laterally away from the shuttle longitudinalaxis 14 _(A1)). For example, FIG. 50A illustrates that the shuttle 14can have two male stops 412 that extend laterally away from the shuttlelongitudinal axis 14 _(A1), for example, as opposed to radially awayfrom the shuttle longitudinal axis 14 _(A1) like the hammerhead designin FIGS. 49A-49H ₄ or like the straight design (also referred to as thediving board design) in FIGS. 33A-36C. The shuttle 14 can have lateralstops in addition to or in lieu of radial stops (e.g., the diving boarddesign or the new hammerhead design). The shuttle 14 can thereby have aretention feature in one plane of the shuttle (e.g., in the radial orlateral plane of the shuttle 14), in two planes (e.g., in the radial andlateral planes of the shuttle 14), or in more planes, where theretention feature can be one or multiple male stops 412. The radial andlateral directions can be perpendicular to each other. The radial andlateral planes can be perpendicular to each other.

FIG. 50A shows, for example, that the shuttle 14 can have radial malestops 412 _(R) and lateral male stops 412 _(L). The shuttle 14 can have0-8 radial male stops 412 _(R), including every 1 radial male stopincrement within this range (e.g., 0 radial male stops, 1 radial malestop, 2 radial male stops). The shuttle 14 can have 0-8 lateral malestops 412 _(L), including every 1 lateral male stop increment withinthis range (e.g., 0 lateral male stops, 1 lateral male stop, 2 lateralmale stops). For example, FIG. 50A illustrates that the shuttle 14 canhave a first radial male stop 412 _(R1), a second radial male stop 412_(R2), a first lateral male stop 412 _(L1), and a second lateral malestop 412 _(L2), or any combination thereof. The radial male stops 412_(R) (e.g., the first and second radial male stops 412 _(R1), 412 _(R2))are also referred to as the male stops 412 (e.g., the first and secondmale stops 412 a, 412 b) in FIGS. 33A-49H ₄, where the male stops 412 inFIGS. 33A-49H ₄ can also be referred to as radial male stops. Thelateral male stops 412 _(L) can have the same features and functions asthe radial male stops 412 _(R) (e.g., shown in FIGS. 33A-49H ₄) but canbe positioned differently on the shuttle 14 (e.g., laterally as opposedto radially), for example, as shown in FIG. 50A.

The lateral male stops 412 _(L) can be anywhere along the length of theshuttle 14. For example, FIG. 50A illustrates that the shuttle firstlongitudinal end 14 _(S1) can have a lateral male stop (e.g., the firstlateral male stop 412 _(L1)) and that the shuttle second longitudinalend 14 _(S2) can have a lateral male stop (e.g., the second lateral malestop 412 _(L2)) in the arrangement shown.

The lateral male stops 412 _(L) can be, for example, springs moveable(e.g., deflectable) toward and away from the shuttle longitudinal axis14 _(A1) as shown by arrows 605 and 607 when engaging and/or disengagingwith a female stop 416. As shown in FIG. 50A, for example, the firstlateral male stop 412 _(L1) can be moveable toward (e.g., arrow 605) theshuttle longitudinal axis 14 _(A1) when exiting a female stop 416 andcan be moveable away from (e.g., arrow 607) the shuttle longitudinalaxis 14 _(A1) when entering a female stop 416. The first lateral malestop 412 _(L1) can be moveable toward (e.g., arrow 605) the shuttlesecond lateral side 14 _(L2) when exiting a female stop 416 and can bemoveable away from (e.g., arrow 607) the shuttle first lateral side 14_(L1) when entering a female stop 416. For example, the first lateralmale stop 412 _(L1) can be moveable toward (e.g., arrow 605) the shuttlelateral side terminal end 14 _(LTE) of the shuttle second lateral side14 _(L2) when exiting a female stop 416 and can be moveable away from(e.g., arrow 607) the shuttle lateral side terminal end 14 _(LTE) of theshuttle first lateral side 14 _(L1) when entering a female stop 416. Asfurther shown in FIG. 50A, the second lateral male stop 412 _(L2) can bemoveable toward (e.g., arrow 605) the shuttle longitudinal axis 14 _(A1)when exiting a female stop 416 and can be moveable away from (e.g.,arrow 607) the shuttle longitudinal axis 14 _(A1) when entering a femalestop 416. The second lateral male stop 412 _(L2) can be moveable toward(e.g., arrow 605) the shuttle first lateral side 14 _(L1) when exiting afemale stop 416 and can be moveable away from (e.g., arrow 607) theshuttle second lateral side 14 _(L2) when entering a female stop 416.For example, the second lateral male stop 412 _(L2) can be moveabletoward (e.g., arrow 605) the shuttle lateral side terminal end 14 _(LTE)of the shuttle first lateral side 14 _(L1) when exiting a female stop416 and can be moveable away from (e.g., arrow 607) the shuttle lateralside terminal end 14 _(LTE) of the shuttle second lateral side 14 _(L2)when entering a female stop 416.

The lateral male stops 412 _(L) can have wider distal ends than proximalends. For example, FIG. 50A illustrates that the male stop secondlongitudinal end 412 _(SE) of the first lateral male stop 412 _(L1) canbe wider than the male stop first longitudinal end 412 _(FE) of thefirst lateral male stop 412 _(L1). FIG. 50A further illustrates that themale stop second section 412 _(S2) of the first lateral male stop 412_(L1) can be wider than the male stop first section 412 _(S1) of thefirst lateral male stop 412 _(L1). FIG. 50A further illustrates that themale stop second longitudinal end 412 _(SE) of the second lateral malestop 412 _(L2) can be wider than the male stop first longitudinal end412 _(FE) of the second lateral male stop 412 _(L2). FIG. 50A furtherillustrates that the male stop second section 412 _(S2) of the secondlateral male stop 412 _(L2) can be wider than the male stop firstsection 412 _(S1) of the second lateral male stop 412 _(L2).

FIG. 50A further illustrates that the lateral male stops 412 _(L) canform part of the shuttle tips 164 (e.g., first and second tips 164 a,164 b) and/or can form part of the shuttle body 160.

The lateral male stops 412 _(L) can be moveable (e.g., deflectable)between multiple configurations. For example, FIG. 50A illustrates thatthe lateral male stops 412 _(L) (e.g., the first and second lateral malestops 412 _(L1), 412 _(L2)) can be moveable (e.g., deflectable) back andforth between the male stop first configuration and the male stop secondconfiguration. The male stop first configuration for the lateral malestops 412 _(L) can be the male stop neutral configuration (also referredto as the male stop non-deflected configuration). The male stop neutralconfiguration can be the configuration of the lateral male stops 412_(L) shown, for example, in FIG. 50A. The lateral male stops 412 _(L)can have the male stop first configuration (e.g., neutralconfiguration), for example, when the lateral male stop 412 _(L) ispartially engaged with a female stop 416, when the male stop 412 isfully engaged with a female stop 416, or both. FIG. 50A illustrates, forexample, that when the lateral male stops 412 _(L) are in the male stopfirst configuration, the shuttle tips 164 can be wider than a centerportion of the shuttle body 160. For example, FIG. 50A illustrates thatwhen the first lateral male stop 412 _(L1) is in the male stop firstconfiguration, the shuttle first tip 164 a can be wider than a centerportion of the shuttle body 160, can be wider than the shuttle width292, or both, and that when the second lateral male stop 412 _(L2) is inthe male stop first configuration, the shuttle first tip 164 b can bewider than a center portion of the shuttle body 160, can be wider thanthe shuttle width 292, or both. FIG. 50A further illustrates that theshuttle 14 can have a space 608 when the lateral male stops 412 _(L) arein the male stop first configuration. The space 608 can be, for example,between the lateral male stops 412 _(L) and the shuttle body 160. FIG.50A illustrates that the space 608 can have multiple arms such that thespace 608 can have an L-shape (e.g., a long arm and a short arm, wherethe arms can be straight, curved or irregular in shape). For example,FIG. 50A illustrates that the space 608 can have an irregular shapedlong arm that terminates in the shuttle tips 164 and a straight shortarm that terminates at or next to a shuttle lateral terminal end 14_(LTE).

The male stop second configuration for the lateral male stops 412 _(L)can be a male stop deflected configuration in which the lateral malestop 412 _(L) is in a configuration different from the male stop neutralconfiguration. For example, the male stop second configuration of thelateral male stops 412 _(L) can be a deflected configuration in whichthe lateral male stop 412 _(L) (e.g., the male stop first section 412_(S1) of the lateral male stop 412 _(L) and/or the male stop secondsection 412 _(S2) of the lateral male stop 412 _(L)) is closer to theshuttle longitudinal axis 14 _(A1), is closer to a shuttle lateral side(e.g., the shuttle first or second lateral side 14 _(L1), 14 _(L2)),and/or is closer to a shuttle lateral side terminal end 14 _(LTE) (e.g.,the shuttle lateral side terminal end 14 _(LTE) of the shuttle firstlateral side 14 _(L1) or of the shuttle lateral side terminal end 14_(LTE) of the shuttle second lateral side 14 _(L2)) than when thelateral male stop 412 _(L) is in the male stop first configuration. Asanother example, the male stop second configuration of the lateral malestops 412 _(L) can be a deflected configuration in which the lateralmale stop 412 _(L) (e.g., the male stop first section 412 _(S1) of thelateral male stop 412 _(L) and/or the male stop second section 412 _(S2)of the lateral male stop 412 _(L)) is farther from the shuttlelongitudinal axis 14 _(A1), is farther from a shuttle lateral side(e.g., the shuttle first or second lateral side 14 _(L1), 14 _(L2)),and/or is farther from a shuttle lateral side terminal end 14 _(LTE)(e.g., the shuttle lateral side terminal end 14 _(LTE) of the shuttlefirst lateral side 14 _(L1) or of the shuttle lateral side terminal end14 _(LTE) of the shuttle second lateral side 14 _(L2)) than when thelateral male stop 412 _(L) is in the male stop first configuration. Thelateral male stops 412 _(L) can have the male stop second configuration(e.g., deflected configuration), for example, when the lateral male stop412 is in a shuttle track (e.g., shuttle tracks 64 and/or 66), when thelateral male stop 16 is partially engaged with a female stop 416, whenthe lateral male stop 412 is not in a female stop 416, or anycombination thereof. The space 608 can be smaller when the lateral malestops 412 _(L) are in the male stop second configuration than when inthe male stop first configuration. For example, the space 608 can bepartially or completely closed when the lateral male stops 412 _(L) arein the male stop second configuration than when in the male stop firstconfiguration. When the lateral male stops 412 _(L) are moved from themale stop first configuration to the male stop second configuration, thelateral male stops 412 _(L) can move into the space 608. When thelateral male stops 412 _(L) move into the space 608, the lateral malestops 412 _(L) can pivot about the shuttle tips 164 (e.g., about shuttlefirst and second tips 164 a, 164 b).

FIG. 50A illustrates the shuttle 14 and the male stops 412 (e.g., theradial and lateral male stops 412 _(R), 412 _(L)) in a flatconfiguration before being shape-set into a curved configuration.

FIG. 50A further illustrates the arrangement of features shown, forexample, with exemplary dimensions D₈-D₁₁, D₁₇-D₂₉, and the shuttlewidth 292.

FIG. 50A illustrates that the dimension D₈ can be, for example, fromabout 0.10 mm to about 0.60 mm, including every 0.01 mm increment withinthis range (e.g., 0.10 mm, 0.28 mm, 0.60 mm).

FIG. 50A illustrates that the dimension D₉ can be, for example, fromabout 0.30 mm to about 1.00 mm, including every 0.01 mm increment withinthis range (e.g., 0.30 mm, 0.66 mm, 1.00 mm).

FIG. 50A illustrates that the dimension D₁₀ can be, for example, fromabout 0.30 mm to about 1.25 mm, including every 0.01 mm increment withinthis range (e.g., 0.30 mm, 0.74 mm, 1.25 mm).

FIG. 50A illustrates that the dimension D₁₁ can be, for example, fromabout 6.00 mm to about 10.00 mm, including every 0.01 mm incrementwithin this range (e.g., 6.00 mm, 8.05 mm, 10.00 mm).

FIG. 50A illustrates that the male stop length 412 _(X) of the radialmale stops 412 _(R) can be, for example, from about 0.30 mm to about1.15 mm, including every 0.01 mm increment within this range (e.g., 0.30mm, 0.64 mm, 1.15 mm).

The radial male stop width 412 _(RW) can be about 0.15 mm to about 0.65mm, including every 0.01 mm increment within this range (e.g., 0.15 mm0.36 mm, 0.65 mm). As another example, the radial male stop width 412_(RW) can be the same dimension as the male stop first section width 412_(S1W).

The dimension D₁₇ can be the length shown, which can be from about 1.40mm to about 4.50 mm, including every 0.01 mm increment within this range(e.g., 1.40 mm, 2.93 mm, 4.50 mm).

The dimension D₁₈ can be the angle shown, which can be from about 80degrees to about 145 degrees, including every 1 degree increment withinthis range (e.g., 80 degrees, 100 degrees, 145 degrees).

The dimension D₁₉ can be the radius of curvature of the shuttle body 160at the position shown, and can be, for example, from about 0.20 mm toabout 0.50 mm, including every 0.01 mm increment within this range(e.g., 0.20 mm, 0.30 mm, 0.50 mm).

The dimension D₂₀ can be the radius of curvature of the shuttle body 160at the position shown, and can be, for example, from about 0.05 mm toabout 0.25 mm, including every 0.01 mm increment within this range(e.g., 0.05 mm, 0.15 mm, 0.25 mm).

FIG. 50B illustrates the shuttle 14 of FIG. 50A in a shape-setconfiguration, and that the dimension D₁ can be, for example, from about4.10 mm to about 8.10 mm, including every 0.01 mm increment within thisrange (e.g., 4.10 mm, 6.10 mm, 8.10 mm) and that the dimension D₄ can befrom about 1.30 mm to about 3.20 mm, including every 0.01 mm incrementwithin this range (e.g., 1.30 mm, 2.31 mm, 3.20 mm).

FIG. 50B further illustrates that the shuttle body 160 and the shuttletips 164 can have the same radius of curvature (e.g., dimension D₃).

FIG. 50C illustrates that the first and second tip surfaces 406 a, 406 bof the shuttle tips 164 (e.g., shuttle first and second tips 164 a, 164b) can be beveled, and that the shuttle width 292 can be, for example,from about 0.40 mm to about 2.00 mm, including every 0.01 mm incrementwithin this range (e.g., 0.40 mm, 1.40 mm, 2.00 mm).

FIGS. 50D and 50E illustrate that the lateral male stops 412 _(L) andthe jaw pushers (e.g., lower and upper jaw pushers 76, 86) can have thedimensions and features shown. FIG. 50D illustrates that the firstlateral male stop 412 _(L1) and the lower jaw pusher 76 can have thedimensions and features shown. FIG. 50E illustrates that the secondlateral male stop 412 _(L2) and the upper jaw pusher 86 can have thedimensions and features shown. The dimensions shown are in millimetersand are exemplary only and can be increased or decreased, for example,by plus or minus 10% to 50% as desired. The upper and lower jaws 30, 38and the female stop 416 in FIGS. 50D and 50E are shown transparent forillustrative purposes so that the features of the shuttle 14, the lowerjaw pusher 76, and the upper jaw pusher 86 can be more easily seen.

FIG. 50D illustrates two configurations of the lower jaw pusher 76 andthe first lateral male stop 412 _(L1), for example, a firstconfiguration in which the lower jaw pusher 76 is not engaged with thefirst lateral male stop 412L_(L) and a second configuration in which thelower jaw pusher 76 is engaged with the first lateral male stop 412_(L1). When the lower jaw pusher 76 is not engaged with the firstlateral male stop 412 _(L1), the shuttle 14 (e.g., the first lateralmale stop 412 _(L1)) can have the features and arrangement shown by thesolid lines in FIG. 50D (e.g., as shown by arrow 610 a) and the lowerjaw pusher 76 can have the features and arrangement shown by the solidlines in FIG. 50D (e.g., as shown by arrow 611). When the lower jawpusher 76 is engaged with the first lateral male stop 412 _(L1), theshuttle 14 (e.g., the first lateral male stop 412 _(L1)) can have thefeatures and arrangement shown by the dashed lines in FIG. 50D (as shownby arrow 612 a) and the lower jaw pusher 76 can have the features andarrangement shown by the dashed lines in FIG. 50D (as shown by arrow613). The configuration of the first lateral male stop 412 _(L1) shownby arrow 610 a is also referred to as the configuration 610 a, where theconfiguration 610 a can be, for example, the male stop firstconfiguration of the first lateral male stop 412 _(L1). Theconfiguration of the first lateral male stop 412 _(L1) shown by arrow612 a is also referred to as the configuration 612 a, where theconfiguration 612 a can be, for example, the male stop secondconfiguration of the first lateral male stop 412 _(L1). Theconfiguration 612 a can be a fully deflected configuration of the firstlateral male stop 412 _(L1).

FIG. 50D illustrates that when the lower jaw pusher 76 is moved intocontact with the second lateral stop 412 _(L2), the second lateral stop412 _(L2) can be moved from the first configuration as shown by arrow610 a to the second configuration as shown by arrow 612 a. The arrow 610a shows, for example, the male stop first configuration of the secondlateral stop 412 _(L2), and the arrow 612 a shows, for example, the malestop second configuration of the second lateral stop 412 _(L2). FIG. 50Dfurther illustrates that the lower jaw pusher 76 can have a lateral stopengager 615. When the lower jaw pusher 76 is moved into contact with thesecond lateral stop 412 _(L2), the lateral stop engager 615 can move thesecond lateral stop 412 _(L2) from the male stop first configuration(e.g., the configuration shown by arrow 610 a) to the male stop secondconfiguration (e.g., the configuration shown by arrow 612 a). Thelateral stop engager 615 can advantageously inhibit or prevent theshuttle 14 and the lower jaw pusher 76 from becoming stuck together bycreating a space 618 between the shuttle first tip 164 a and the lowerjaw pusher 76 when the shuttle first tip 164 a is in the shuttle seat274 of the lower jaw pusher 76. FIG. 50D further illustrates that thelower jaw pusher 76 can have a tip space 620 that inhibits or preventsthe terminal tip 165 of the shuttle first tip 164 a from contacting thelower jaw pusher 76 to inhibit or prevent the lower jaw pusher 76 fromdulling or chipping the shuttle first tip 164 a (e.g., the terminal tip165).

FIG. 50E illustrates two configurations of the upper jaw pusher 86 andthe second lateral male stop 412 _(L2), for example, a firstconfiguration in which the upper jaw pusher 86 is not engaged with thesecond lateral male stop 412L₂, and a second configuration in which theupper jaw pusher 86 is engaged with the second lateral male stop 412_(L2). When the upper jaw pusher 86 is not engaged with the secondlateral male stop 412 _(L2), the shuttle 14 (e.g., the second lateralmale stop 412 _(L2)) can have the features and arrangement shown by thesolid lines in FIG. 50E (e.g., as shown by arrow 610 b) and the upperjaw pusher 86 can have the features and arrangement shown by the solidlines in FIG. 50E (e.g., as shown by arrow 611). When the upper jawpusher 86 is engaged with the second lateral male stop 412 _(L2), theshuttle 14 (e.g., the second lateral male stop 412 _(L2)) can have thefeatures and arrangement shown by the dashed lines in FIG. 50E (as shownby arrow 612 b) and the upper jaw pusher 86 can have the features andarrangement shown by the dashed lines in FIG. 50E (as shown by arrow613). The configuration of the second lateral male stop 412 _(L2) shownby arrow 610 b is also referred to as the configuration 610 b, where theconfiguration 610 b can be, for example, the male stop firstconfiguration of the second lateral male stop 412 _(L2). Theconfiguration of the second lateral male stop 412 _(L2) shown by arrow612 b is also referred to as the configuration 612 b, where theconfiguration 612 b can be, for example, the male stop secondconfiguration of the second lateral male stop 412 _(L2). Theconfiguration 612 b can be a fully deflected configuration of the secondlateral male stop 412 _(L2).

FIG. 50E illustrates that when the upper jaw pusher 86 is moved intocontact with the first lateral stop 412 _(L1), the first lateral stop412 _(L1) can be moved from the first configuration as shown by arrow610 b to the second configuration as shown by arrow 612 b. The arrow 610b shows, for example, the male stop first configuration of the firstlateral stop 412 _(L1), and the arrow 612 b shows, for example, the malestop second configuration of the first lateral stop 412 _(L1). FIG. 50Efurther illustrates that the upper jaw pusher 86 can have a lateral stopengager 615. When the upper jaw pusher 86 is moved into contact with thefirst lateral stop 412 _(L1), the lateral stop engager 615 can move thefirst lateral stop 412 _(L1) from the male stop first configuration(e.g., the configuration shown by arrow 610 b) to the male stop secondconfiguration (e.g., the configuration shown by arrow 612 b). Thelateral stop engager 615 can advantageously inhibit or prevent theshuttle 14 and the upper jaw pusher 86 from becoming stuck together bycreating a space 618 between the shuttle second tip 164 b and the upperjaw pusher 86 when the shuttle second tip 164 b is in the shuttle seat274 of the upper jaw pusher 86. FIG. 50E further illustrates that theupper jaw pusher 86 can have a tip space 620 that inhibits or preventsthe terminal tip 165 of the shuttle second tip 164 b from contacting theupper jaw pusher 86 to inhibit or prevent the upper jaw pusher 86 fromdulling or chipping the shuttle second tip 164 b (e.g., the terminal tip165).

FIGS. 50F and 50G illustrate that upper and lower jaws 30, 38 can eachhave one or multiple lateral female stops 416 _(L) that can, forexample, extend laterally away from the shuttle tracks (e.g., from theupper and lower jaw shuttle tracks 64, 66). The shuttle tracks 64 and 66are shown in 50F and 50G with the rest of the upper and lower jaws 30,38 shown transparent for illustrative purposes. The lower jaw 38 canhave, for example, 0-8 lateral female stops 416 _(L), including every 1lateral female stop increment within this range (e.g., 0 lateral femalestops, 1 lateral female stop, 2 lateral female stops). The upper jaw 30can have, for example, 0-8 lateral female stops 416 _(L), includingevery 1 lateral female stop increment within this range (e.g., 0 lateralfemale stops, 1 lateral female stop, 2 lateral female stops). Forexample, FIGS. 50F and 50G illustrate that the lower jaw 38 can have afirst lateral female stop 416 _(L1) and that the upper jaw 30 can have asecond lateral female stop 416 _(L2). FIG. 50F illustrates that thefirst lateral female stop 416 _(L1) can extend laterally away from thelower jaw shuttle track 66 and FIG. 50G illustrates that the secondlateral female stop 416 _(L2) can extend laterally away from the upperjaw shuttle track 64. For example, the first lateral female stop 416_(L1) can extend laterally away from the longitudinal axis (e.g., acenter longitudinal axis 66 _(LA)) of the lower jaw shuttle track 66,and the second lateral female stop 416 _(L2) can extend laterally awayfrom the longitudinal axis (e.g., a center longitudinal axis 64 _(LA))of the upper jaw shuttle track 64, for example, as opposed to radiallyaway from the longitudinal axis of the upper jaw shuttle tracks 66, 64like the female stops 416 in FIGS. 33A-35 and 49H ₁-49H₄.

The upper and lower jaws 30, 38 can have lateral female stops 416 _(L)in addition to or in lieu of radial female stops (e.g., the female stops416 in FIGS. 33A-35 and 49H ₁-49H₄). The upper and lower jaws 30, 38 canthereby have a retention feature in one plane of the jaws (e.g., in theradial or lateral plane of the upper and/or lower jaws 30, 38), in twoplanes (e.g., in the radial and lateral planes of the upper and/or lowerjaws 30, 38), or in more planes, where the retention feature can be oneor multiple female stops 416. The female stops 416 in FIGS. 33A-35 and49H ₁-49H₄ are also referred to as radial female stops 416 _(R) (e.g.,the first female stop 416 a and the second female stop 416 b). Thelateral female stops 416 _(L) can have the same features and functionsas the radial female stops 416 _(R) (e.g., shown in FIGS. 33A-35 and 49H₁-49H₄) but can be positioned differently on in the jaws (e.g., they canextend laterally as opposed to radially), for example, as shown in FIGS.50F and 50G.

FIG. 50F further illustrates that when the first lateral male stop 412_(L1) is engaged with the first lateral female stop 416 _(L1), the firstlateral male stop 412 _(L1) can have the male stop first configuration(e.g., a partially deflected configuration or a neutral configurationsuch as, for example, the configuration 610 a). FIG. 50F furtherillustrates that when the first lateral male stop 412 _(L1) is engagedwith the first lateral female stop 416 _(L1), the second lateral malestop 412 _(L2) can have the male stop first configuration (e.g., apartially deflected configuration or a neutral configuration such as,for example, the configuration 610 b). When the first lateral male stop412 _(L1) is engaged with the first lateral female stop 416 _(L1), themale stop first configuration of the second lateral male stop 412 _(L2)can be the same male stop first configuration of the first lateral malestop 412 _(L1) (e.g., as shown in FIG. 50F). The configuration 610 a canbe, for example, the same as the configuration 610 b. As anotherexample, when the first lateral male stop 412 _(L1) is engaged with thefirst lateral female stop 416 _(L1), the male stop first configurationof the second lateral male stop 412 _(L1) can be different from the malestop first configuration of the first lateral male stop 412 _(L1). Forexample, when the first lateral male stop 412 _(L1) is engaged with thefirst lateral female stop 416 _(L1), the second lateral male stop 412_(L2) can have the male stop second configuration (e.g., theconfiguration 612 b or a partially deflected configuration somewherebetween the configurations 610 b and 612 b). FIG. 50F furtherillustrates that the longitudinal axis 76 _(LA) of the lower jaw pusher76, the longitudinal axis 66 _(LA) of the lower jaw shuttle track 66,and the shuttle longitudinal axis 14 _(A1) can be coincident with eachother when the shuttle 14 is in the lower jaw 38. The shuttle 14, thelower jaw shuttle track 66, and the lower jaw pusher 76 are shown flatin FIG. 50F for illustrative purposes to more easily see therelationship between the features shown.

FIG. 50G further illustrates that when the second lateral male stop 412_(L2) is engaged with the second lateral female stop 416 _(L2), thesecond lateral male stop 412 _(L2) can have the male stop firstconfiguration (e.g., a partially deflected configuration or a neutralconfiguration such as, for example, the configuration 610 b). FIG. 50Gfurther illustrates that when the second lateral male stop 412 _(L2) isengaged with the second lateral female stop 416 _(L2), the first lateralmale stop 412 _(L1) can have the male stop first configuration (e.g., apartially deflected configuration or a neutral configuration such as,for example, the configuration 610 a). When the second lateral male stop412 _(L2) is engaged with the second lateral female stop 416 _(L2), themale stop first configuration of the first lateral male stop 412 _(L1)can be the same male stop first configuration of the second lateral malestop 412 _(L2) (e.g., as shown in FIG. 50G). As another example, whenthe second lateral male stop 412 _(L2) is engaged with the secondlateral female stop 416 _(L2), the male stop first configuration of thefirst lateral male stop 412 _(L1) can be different from the male stopfirst configuration of the second lateral male stop 412 _(L2). Forexample, when the second lateral male stop 412 _(L2) is engaged with thesecond lateral female stop 416 _(L2), the first lateral male stop 412_(L1) can have the male stop second configuration (e.g., theconfiguration 612 a or a partially deflected configuration somewherebetween the configurations 610 a and 612 a). FIG. 50G furtherillustrates that the longitudinal axis 86 _(LA), of the upper jaw pusher86, the longitudinal axis 64 _(LA) of the upper jaw shuttle track 64,and the shuttle longitudinal axis 14 _(A1) can be coincident with eachother when the shuttle 14 is in the upper jaw 30. The shuttle 14, theupper jaw shuttle track 64, and the upper jaw pusher 86 are shown flatin FIG. 50G for illustrative purposes to more easily see therelationship between the features shown.

FIGS. 50F and 50G illustrate that the lateral male stops 412 _(L) can besprings biased to have the male stop first configuration. For example,when the lateral male stops 412 _(L) (e.g., the first and second lateralmale stops 412 _(L1), 412 _(L2)) are in the male stop secondconfiguration, the lateral male stops 412 _(L) can be biased to return(e.g., passively return) to the male stop first configuration. Forexample, when the lateral male stops 412 _(L) are in the male stopsecond configuration, the lateral male stops 412 _(L) can be biased torebound or spring back to the male stop first configuration. This canadvantageously allow the lateral male stops 412 _(L) (e.g., the firstand second lateral male stops 412 _(L1), 412 _(L2)) to passively engagewith the lateral female stops 416 _(L) (e.g., the first and secondlateral female stops 416 _(L1), 416 _(L2)) as lateral male stops 412_(L) are moved into the lateral female stops 416L.

FIG. 50H ₁ illustrates the lower jaw shuttle track 66 of FIG. 50F havinga curve in the lower jaw 38, with half of the lower jaw 38 showntransparent for illustrative purposes.

FIG. 50H ₁ further illustrates that the first lateral female stop 416_(L1) can be straight. As another example, the first lateral female stop416 _(L1) can have a curve having a radius of curvature that is the sameas, for example, the radius of curvature of the shuttle 14.

FIG. 50H ₁ further illustrates that the lower jaw 38 can have a radialfemale stop 416 _(R), a lateral female stop 416 _(L), or both. Forexample, the lower jaw 38 can have a first radial female stop 416 _(R1)and the first lateral female stop 416 _(L1).

FIG. 50H ₂ illustrates the shuttle 14 in the lower jaw 38 of FIG. 50H ₁with half of the lower jaw 38 shown transparent for illustrativepurposes. FIG. 50H ₂ illustrates the first lateral male stop 412 _(L1)engaged with the first lateral female stop 416 _(L1), and the firstradial male stop 412 _(R1) engaged with the first radial female stop 416_(R1).

FIG. 50H ₃ illustrates the upper jaw shuttle track 64 of FIG. 50G havinga curve in the upper jaw 30, with half of the upper jaw 30 showntransparent for illustrative purposes.

FIG. 50H ₃ further illustrates that the second lateral female stop 416_(L2) can be straight. As another example, the second lateral femalestop 416 _(L2) can have a curve having a radius of curvature that is thesame as, for example, the radius of curvature of the shuttle 14.

FIG. 50H ₃ further illustrates that the upper jaw 30 can have a radialfemale stop 416 _(R), a lateral female stop 416 _(L), or both. Forexample, the upper jaw 30 can have a second radial female stop 416 _(R2)and the second lateral female stop 416 _(L2).

FIG. 50H ₄ illustrates the shuttle 14 in the upper jaw 30 of FIG. 50H ₃with half of the upper jaw 30 shown transparent for illustrativepurposes. FIG. 50H ₄ illustrates the second lateral male stop 412 _(L2)engaged with the second lateral female stop 416 _(L2), and the secondradial male stop 412 _(R2) engaged with the second radial female stop416 _(R2).

FIGS. 50H ₂ 50H₄ further illustrate that the first radial male stop 412_(R1) can have a hammer head shape (e.g., the same hammer head shape asthe first male stop 412 a in FIGS. 49A-49H ₄) and that the second radialmale stop 412 _(R2) can have a hammer head shape (e.g., the same hammerhead shape as the second male stop 412 b in FIGS. 49A-49H ₄)

The radial shuttle female stops 416 _(R) (e.g., the first and secondradial shuttle female stops 416 _(R1), 416 _(R2)) are also referred toas the female stops 416 (e.g., the first and second female stops 416 a,416 b) in FIGS. 33A-35 and 49H ₁-49H₄.

FIGS. 50H ₁-50H₄ together illustrate, for example, the shuttle 14 withfour male stops 412 and the upper and lower jaws 30, 38 each with twofemale stops 416. The male stops 412 can deflect toward the shuttlelongitudinal axis 14 _(A1) when the shuttle 14 is moved away from thefemale stops 416 the shuttle 14 is engaged with.

FIGS. 51A-51L illustrate the male stops 412 can have the shapes andfeatures shown, and that the shuttle 14 can have any combination of themale stops 412 shown. The male stops 412 in FIGS. 51A-51L can be, forexample, radial male stops 412 _(R). As another example, the male stops412 in FIGS. 51A-51L can be lateral male stops 412 _(L). As yet anotherexample, the male stops 412 in FIGS. 51A-51L can be radial and/orlateral male stops, whereby they can have a radial component and/or alateral component. The shuttles 14 in FIGS. 51A-51L are shown in a flatconfiguration before being shape-set into a curved configuration. Whenthe shuttles 14 in FIGS. 51A-51L are in a shape set configuration, theshuttles 14 can have the same radius of curvature of the other shape setshuttles 14 described and/or contemplated herein. For example, theshuttle 14 in FIGS. 33A-36C, 38A-38C, 49A-50G, 50H ₂, and 50H₄ can haveany combination of the male stops 412 shown in FIGS. 33A-36C, 38A-38C,49A-50G, 50H ₂, 50H₄, and 51A-51L. For example, one or both of the malestops 412 in FIGS. 33A-36C, 49A-50G, 50H ₂, and 50H₄, can any of themale stops 412 shown in FIGS. 51A-51L.

FIGS. 51A-51L that the male stops 412 can have a proximal end (e.g., themale stop first longitudinal end 412 _(FE)) wider than a distal end(e.g., the male stop second longitudinal end 412 _(SE)), can have adistal end (e.g., the male stop second longitudinal end 412 _(SE)) widerthan a proximal end (e.g., the male stop first longitudinal end 412_(FE)), can have a symmetric shape (e.g., about the shuttle longitudinalaxis 14 _(A1)), can have an asymmetric shape (e.g., about the shuttlelongitudinal axis 14 _(A1)), can have a hooked shape, can have multiplearms with or without support between the multiple arms, can have reliefcuts (e.g., along the perimeter of the male stops, on the sides of themale stops, on the distal terminal end of the male stops), any otherfeature and/or shape shown in FIGS. 51A-51L, or any combination thereof.

The various shapes of the male stops 412 in FIGS. 33A-36C, 49A-50G, 50H₂, 50H₄, and 51A-51L are exemplary ways to tune the catch force and therelease force independently, for example, through the geometry of themale stops 412 and the mating catch geometry with the female stops 416.These exemplary shapes can advantageously pierce and transit throughtissue when the shuttle 14 is moved from one jaw to the other. Theability to tune different portions of the male stops 412 as shown inthese figures is important. For example, some of the shapes andgeometries in FIGS. 51A-51L are similar to the hammerhead shape, butvary along the bending length to tune the bending resistance. Others caninterface with different catch designs of the female stops 416. Forexample, the male stops 412 with a hook shape (e.g., FIG. 51A, 51D, 51E,51H, 51K) can provide catch forces that are lower than the releaseforces. The male stops 412 that have a hook shape can, for example,interface with a hook receiver (e.g., a hole or cross-pin) on the jawthat can catch the hook. The asymmetric designs (e.g., FIG. 51A, 51E,51H, 51K, 51L) can require a torque or a rotation from the pusher (e.g.,the lower jaw pusher 76 or the upper jaw pusher 86) to make the malestops 412 to catch the female stop 416 and/or release from the femalestop 416, which can be different from the hammerhead shape that cancatch and release from the female stops 416 with linear bending. Thetapered or angled designs (e.g., 51A, 51B, 51C, 51F, 51G, 51J) can havea catch force different from the release force and/or the catch andrelease forces can be tuned, for example, by replacing surface onsurface contact between the male and female stops 412, 416 with line orpoint on surface contact between the male and female stops 412, 416. Thedesigns with splits along the length or width (e.g., FIGS. 511, 51L) cancombine the bendable (e.g., linearly bendably) male stops (e.g., FIGS.33A-33C and 49A-49H ₄) with a lateral catcher (e.g., the lateral malestops 412 _(L)).

The female stops 416 in the upper and lower jaws 30, 38 can have a shapeto mate with the male stops 412 illustrated in FIGS. 51A-51L.

FIG. 52A illustrates that the male stop 412 can have the features shown.The male stop 412 can have a locker 702 and one or multiple male stoparms 704. The male stop arms 704 can have or can be springs 704 _(S).The springs 704 _(S) can be, for example, one or multiple bends in themale stop arms 704 _(S). The male stop 412 can have a channel 703. Theshuttle 14 can be moveable through the channel 703 when the locker 702is in an unlocked position. The shuttle 14 can be prevented from movingthrough the channel 703 when the locker 702 is in a locked position. Forexample, FIG. 52B illustrates the locker 702 in an unlocked position andFIG. 52C illustrates the locker 702 in a locked position.

FIGS. 52B and 52C illustrate that the male stop 412 can be moveable in achannel 707 in the jaws. The male stop 412 can be moveable in thechannel 707, for example, by the jaw control extension 40, by thesprings 704 _(S), or by both. The jaw control extension arms 548 canengage and disengage with the male stop arms 704, for example, as thejaws are opened and closed by the jaw control extension 40. FIG. 52Billustrates that the jaw control extension 40 can be moved in direction708 relative to the jaws and/or the male stop 412 to engage with themale stop 412, and FIG. 52C illustrates that the jaw control extension40 can be moved in direction 710 relative to the jaws and/or the malestop 412 to disengage from the male stop 412.

FIG. 52B illustrates that when the jaws are in a closed configuration,the male stop 412 can be in an advanced position (e.g., having beenactively pushed forward by the jaw control extension 40) out of the wayof the shuttle 14 and/or out of the way of a male stop on the shuttle14, so that the shuttle 14 can be moveable through channel 703. In FIG.52B, the male stop 412 is shown pressed forward by the jaw controlextension 40, allowing the shuttle 14 to be released from the male stop412. FIG. 52B illustrates that when the locker 702 is pushed fullyforward, the locker 702 can be moved out of the path of the shuttleand/or out of the path of a male stop 412 on the shuttle 14. FIG. 52Bshows, for example, the active retention when the locker 702 is in adisengaged position (e.g., when the jaws are closed), allowing freemotion of the shuttle 14.

FIG. 52C illustrates that when the jaws are in an open configuration,the male stop 412 can be in a retracted position (e.g., having beensprung backward into the channel 707 via the springs 704 _(S)), forminga catch for the shuttle 14 and/or for a male stop 412 on the shuttle 14to inhibit or prevent the shuttle 14 from moving out of the jaw, forexample, through the channel 703. For example, FIG. 52C illustrates thatwhen the jaws are in an open configuration, the locker 702 can form acatch for the shuttle 14 by pressing against the shuttle body 160 and/orcan form a catch for a male stop 412 on the shuttle 14 to inhibit orprevent the shuttle 14 from moving through the channel 703. FIG. 52Cillustrates that when the male stop 412 is in a retracted position, thelocker 702 can be moved into the path of the shuttle 14 and/or into thepath of a male stop 412 on the shuttle 14, blocking motion of theshuttle 14. FIG. 52C shows, for example, the active retention when thelocker 702 is in an engaged position (e.g., when the jaws are open),restricting motion of the shuttle 14.

FIGS. 52B and 52C together illustrate, for example, that the jaw controlextension 40 can push the male stop 40 forward in the channel 707 so thelocker 702 is clear of (e.g., forward of, distal of) the shuttle 14and/or of a male stop 412 on the shuttle 14, and that the springs 704 Scan retract the male stop 412 into the channel 707 so that the locker702 can inhibit or block movement of the shuttle 14 and/or of a malestop 412 on the shuttle. For example, FIG. 52C illustrates that when thejaw control extension 40 is retracted or the jaws are advanced over thejaw control extension 40, that the springs 704 _(S) can rebound back toa neutral configuration (e.g., the configuration shown in FIG. 52A). Thesprings 704 _(S) returning to their neutral configuration can retractthe male stop 412 into the channel 707 to lock the shuttle 14 inposition.

FIG. 52B further illustrates that when the jaw control extension 40 isin a fully advanced configuration, the male stop arms 704 can be pressedagainst a surface 711 defining an arm space 712. FIG. 52C furtherillustrates that when the jaw control extension 40 is in a retractedconfiguration (e.g., a fully retracted configuration), the male stoparms 704 can be in less contact with the surface 711 than when the jawcontrol extension 40 is in an advanced configuration (e.g., the fullyadvanced configuration shown in FIG. 52B). For example, as the springs704 _(S) return to a neutral configuration as the jaw control extension40 is retracted, the male stop arms 704 can press against the surface711 and create the gap between the male stop arms 704 and the surface711 shown in FIG. 52C.

FIGS. 52B and 52C further illustrate that male stop channel 707 can havea first section on a first side of the shuttle track and a secondsection on a second side of the shuttle track.

FIGS. 52B and 52C further illustrate that the device 188 may or may nothave passive male stops 412 in addition to the male stop 412 that can beactively engaged with the shuttle 14 and/or can be positionable to blockmovement of a passive male stop extending from the shuttle 14. Thepassive male stops 412 can be any of the male stops described,illustrated, and/or contemplated herein. For example, FIGS. 52B and 52Cillustrate that the passive male stops 412 can be radial male stops 412_(R). FIGS. 52B and 52C further illustrate that the device 188 can havepassive female stops 416 for the passive male stops 412. The passivefemale stops 412 can be any of the female stops described, illustrated,and/or contemplated herein. For example, FIGS. 52B and 52C illustratethat the passive female stops 416 can be radial female stops 416 _(R).

Half of the upper jaw 30 and the features therein are shown transparentin FIGS. 52B and 52C for illustrative purposes.

FIG. 52D illustrates a close-up view of the male shuttle channel 707intersecting with the upper jaw shuttle track 64.

FIG. 52E illustrates a close-up view showing that when the male stop 412is in a disengaged position (e.g., jaws closed), the locker 702 can bepushed away from the shuttle 14 so that the male stop on the shuttle 14can pass beneath it. In the engaged scenario (e.g., as shown in FIG.52C) the locker 702 can be moved down (e.g., from its built in springs704 and 704 _(S)) to block the forward path of the male stop 412 on theshuttle 14.

FIGS. 52A-52E illustrate that male stops 412 can be engageable anddisengageable with one another. For example, a first male stop 412 canbe engageable and disengageable with a second male stop 412. The secondmale stop 412 can be, for example, on the shuttle 14 and/or can extendfrom the shuttle 14.

Any male stop 412 can be replaced with a female stop 416 and vice versa.For example, any of the male and female stops 412, 416 in FIGS. 49A-50H₄ can be swapped with each other such that the shuttle 14 has the femalestops 416 and the upper and lower jaws have the male stops 412.

The upper and lower jaws referred to throughout the application can beany of the upper and lower jaws disclosed, illustrated, and/orcontemplated herein. For example, the upper and lower jaws 30, 48 can bethe upper and lower jaws 78, 80, respectively. As another example, theupper jaw 30 can be interchangeable with the upper jaw 78, and the lowerjaw 38 can be interchangeable with the upper jaw 80. As yet anotherexample, the upper jaw 30 can also be referred to as the upper jaw 78,and the lower jaw 38 can also be referred to as the lower jaw 80. Thelower jaw can be a first jaw and the upper jaw can be a second jaw. Thelower jaw can be a second jaw and the upper jaw can be a first jaw.

The features in FIGS. 1a -52D, the features described herein, and/or thefeatures contemplated herein can be combined with each other in anycombination. For example, the shuttle 14 in any of the figures can beany of the shuttles 14 illustrated, described, and/or contemplatedherein. For example, FIGS. 49H ₁-49H₄ illustrate that the shuttle 14moveable by the device 188 can have male stops 412 that have ahammerhead shape.

For example, a suture manipulating device is disclosed that can have afirst jaw. The first jaw can have a first jaw channel (e.g., upper jawtrack 64 or lower jaw track 66) and a first jaw first stop (e.g., a malestop 412 or a female stop 416). The suture manipulating device can havea shuttle. The shuttle can have a shuttle longitudinal axis and ashuttle first stop (e.g., a male stop 412 or a female stop 416). Theshuttle can be slideable in the first jaw channel. The shuttle firststop can extend away from the shuttle longitudinal axis. The shuttlefirst stop can have a shuttle first stop proximal end (e.g., male stopfirst longitudinal end 412 _(FE)) and a shuttle first stop distal end(e.g., male stop second longitudinal end 412 _(SE)). The shuttle firststop proximal end can be narrower than the shuttle first stop distalend. The shuttle first stop distal end can be deflectable into the firstjaw first stop. The shuttle first stop can be engageable with the firstjaw first stop. When the shuttle first stop is engaged with the firstjaw first stop, the shuttle first stop distal end can be in contact withthe first jaw first stop. When the shuttle first stop distal end is incontact with the first jaw first stop, the shuttle can be passivelyretained in the first jaw.

The suture manipulating device can have a second jaw. The second jaw canhave a second jaw channel (e.g., upper jaw track 64 or lower jaw track66) and a second jaw first stop (e.g., a male stop 412 or a female stop416). The shuttle can be slideable in the second jaw channel.

The shuttle can have a shuttle second stop (e.g., a male stop 412 or afemale stop 416). The shuttle first stop can be slideable into and outof the first jaw first stop. The shuttle second stop can be slideableinto and out of the second jaw first stop.

The shuttle second stop can extend away from the shuttle longitudinalaxis. The shuttle second stop can have a shuttle second stop proximalend (e.g., male stop first longitudinal end 412 _(FE)) and a shuttlesecond stop distal end (e.g., male stop second longitudinal end 412_(SE)). The shuttle second stop proximal end can be narrower than theshuttle second stop distal end. The shuttle second stop distal end canbe deflectable into the second jaw first stop. The shuttle second stopcan be engageable with the second jaw first stop. When the shuttlesecond stop is engaged with the second jaw first stop, the shuttlesecond stop distal end can be in contact with the second jaw first stop.When the shuttle second stop distal end is in contact with the secondjaw first stop, the shuttle can be passively retained in the second jaw.

The shuttle first stop distal end can be closer to a center of theshuttle than the shuttle first stop proximal end. The shuttle secondstop distal end can be closer to the center of the shuttle than theshuttle second stop proximal end.

At least one of the shuttle first stop and the shuttle second stop canbe a male stop.

At least one of the shuttle first stop and the shuttle second stop canhave a hammerhead shape.

The shuttle first stop can extend radially away from the shuttlelongitudinal axis, and the shuttle second stop can extend radially awayfrom the shuttle longitudinal axis.

The shuttle first stop can extend radially away from the shuttlelongitudinal axis, and the shuttle second stop can extend laterally awayfrom the shuttle longitudinal axis.

The shuttle first stop can extend laterally away from the shuttlelongitudinal axis, and the shuttle second stop can extend laterally awayfrom the shuttle longitudinal axis.

When the shuttle first stop is engaged with the first jaw first stop,tissue can be moveable away from the first jaw first stop via theshuttle first stop.

The shuttle can have a shuttle first section, a shuttle second section,and a shuttle third section. The shuttle first section can be straight,the shuttle second section can be curved, and the shuttle third sectioncan be straight.

Before the shuttle is loaded into the first jaw channel, the shuttle canhave a first radius of curvature. After the shuttle is loaded into thefirst jaw channel, the shuttle can have a second radius of curvature.The second radius of curvature can be less than the first radius ofcurvature. The shuttle can be biased to have the first radius ofcurvature.

The first jaw can have a first jaw second stop (e.g., a male stop 412 ora female stop 416). The shuttle can have a shuttle third stop (e.g., amale stop 412 or a female stop 416). The shuttle third stop can extendaway from the shuttle longitudinal axis. The shuttle third stop can havea shuttle third stop proximal end (e.g., male stop first longitudinalend 412 _(FE)) and a shuttle third stop distal end (e.g., male stopsecond longitudinal end 412 _(SE)). The shuttle third stop proximal endcan be narrower than the shuttle third stop distal end. The shuttlethird stop distal end can be deflectable into the first jaw second stop.The shuttle third stop can be engageable with the first jaw second stop.When the shuttle third stop is engaged with the first jaw second stop,the shuttle third stop distal end can be in contact with the first jawsecond stop. When the shuttle third stop distal end is in contact withthe first jaw third stop, the shuttle can be passively retained in thefirst jaw. The shuttle third stop can be slideable into and out of thefirst jaw second stop.

The second jaw can have a second jaw second stop (e.g., a male stop 412or a female stop 416). The shuttle can have a shuttle fourth stop (e.g.,a male stop 412 or a female stop 416). The shuttle fourth stop can beslideable into and out of the second jaw second stop. The shuttle fourthstop can extend away from the shuttle longitudinal axis. The shuttlefourth stop can have a shuttle fourth stop proximal end (e.g., male stopfirst longitudinal end 412 _(FE)) and a shuttle fourth stop distal end(e.g., male stop second longitudinal end 412 _(SE)). The shuttle fourthstop proximal end can be narrower than the shuttle fourth stop distalend. The shuttle fourth stop distal end can be deflectable into thesecond jaw second stop. The shuttle fourth stop can be engageable withthe second jaw second stop. When the shuttle fourth stop is engaged withthe second jaw second stop, the shuttle fourth stop distal end can be incontact with the second jaw second stop. When the shuttle fourth stopdistal end is in contact with the second jaw second stop, the shuttlecan be passively retained in the second jaw.

The shuttle first stop can be a radial male stop (e.g., 412 _(R)) or alateral male stop (e.g., 412 _(L)). The shuttle first stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The shuttle second stop can be a radial male stop (e.g., 412 _(R)) or alateral male stop (e.g., 412 _(L)). The shuttle second stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The shuttle third stop can be a radial male stop (e.g., 412 _(R)) or alateral male stop (e.g., 412 _(L)). The shuttle third stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The shuttle fourth stop can be a radial male stop (e.g., 412 _(R)) or alateral male stop (e.g., 412 _(L)). The shuttle fourth stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The first jaw first stop can be a radial male stop (e.g., 412 _(R)) or alateral male stop (e.g., 412 _(L)). The first jaw first stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The second jaw first stop can be a radial male stop (e.g., 412 _(R)) ora lateral male stop (e.g., 412 _(L)). The second jaw first stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The first jaw second stop can be a radial male stop (e.g., 412 _(R)) ora lateral male stop (e.g., 412 _(L)). The first jaw second stop can be aradial female stop (e.g., 416 _(R)) or a lateral female stop (e.g., 416_(L)).

The second jaw second stop can be a radial male stop (e.g., 412 _(R)) ora lateral male stop (e.g., 412 _(L)). The second jaw second stop can bea radial female stop (e.g., 416 _(R)) or a lateral female stop (e.g.,416 _(L)).

As another example, a suture manipulating device is disclosed that canhave a jaw structure (e.g., jaw structure 28). The jaw structure canhave a shuttle channel (e.g., upper jaw track 64 and/or the lower jawtrack 66, where when the jaw structure is in a closed configuration, thejaw structure can form a continuous track defined, for example, by theupper and lower jaw tracks 64, 66) having a shuttle channel first stop(e.g., a male stop 412 or a female stop 416). The suture manipulatingdevice can have a shuttle. The shuttle can have a shuttle longitudinalaxis and a shuttle first stop (e.g., a male stop 412 or a female stop416). The shuttle can be slideable in the shuttle channel. The shuttlefirst stop can extend away from the shuttle longitudinal axis. Theshuttle first stop can have a shuttle first stop proximal end (e.g.,male stop first longitudinal end 412 _(FE)) and a shuttle first stopdistal end (e.g., male stop second longitudinal end 412 _(SE)). Theshuttle first stop proximal end can be narrower than the shuttle firststop distal end. The shuttle first stop can be moveable into the shuttlechannel first stop. The shuttle first stop can be engageable with theshuttle channel first stop. When the shuttle first stop is not engagedwith the shuttle channel first stop, the shuttle first stop can have ashuttle first stop non-deflected shape. When the shuttle first stop isengaged with the shuttle channel first stop, the shuttle first stop canhave a shuttle first stop deflected shape.

The shuttle channel can have a shuttle channel second stop (e.g., a malestop 412 or a female stop 416).

The shuttle can have a shuttle second stop (e.g., a male stop 412 or afemale stop 416).

The shuttle second stop can extend away from the shuttle longitudinalaxis. The shuttle second stop can have a shuttle second stop proximalend (e.g., male stop first longitudinal end 412 _(FE)) and a shuttlesecond stop distal end (e.g., male stop second longitudinal end 412_(SE)). The shuttle second stop proximal end can be narrower than theshuttle second stop distal end. The shuttle second stop can be moveableinto the shuttle channel second stop. The shuttle second stop can beengageable with the shuttle channel second stop. When the shuttle secondstop is not engaged with the shuttle channel second stop, the shuttlesecond stop can have a shuttle second stop non-deflected shape. When theshuttle second stop is engaged with the shuttle channel second stop, theshuttle second stop can have a shuttle second stop deflected shape.

The shuttle first stop distal end can be closer to a center of theshuttle than the shuttle first stop proximal end. The shuttle secondstop distal end can be closer to the center of the shuttle than theshuttle second stop proximal end. When the shuttle first stop is engagedwith the shuttle channel first stop, movement of the shuttle in theshuttle channel can be restricted. When the shuttle second stop isengaged with the shuttle channel second stop, movement of the shuttle inthe shuttle channel can be restricted.

At least one of the shuttle first stop and the shuttle second stop canbe a male stop.

At least one of the shuttle first stop and the shuttle second stop canhave a hammerhead shape.

The shuttle first stop can extend radially away or laterally away fromthe shuttle longitudinal axis, and the shuttle second stop can extendradially away or laterally away from the shuttle longitudinal axis.

The shuttle channel first stop and the shuttle channel second stop canbe in a first jaw of the suture manipulating device.

The shuttle channel first stop can be in a first jaw of the suturemanipulating device, and the shuttle channel second stop can be in asecond jaw of the suture manipulating device.

As another example, a suture manipulating device is disclosed that canhave a jaw. The jaw can have a shuttle channel (e.g., upper jaw track 64and/or the lower jaw track 66) having a female stop (e.g., female stop416). The suture manipulating device can have a shuttle. The shuttle canhave a shuttle longitudinal axis and a male stop (e.g., male stop 412).The shuttle can be translatable in the shuttle channel. The male stopcan be engageable with the female stop. The male stop can extend awayfrom the shuttle longitudinal axis. The male stop can have a male stopproximal end (e.g., male stop first longitudinal end 412 _(FE)) and amale stop distal end (e.g., male stop second longitudinal end 412_(SE)). The male stop distal end can be wider than the male stopproximal end. The male stop can be translatable into and out of thefemale stop. The male stop can be deflectable into and out of the femalestop.

The first male stop can extend radially away or laterally away from theshuttle longitudinal axis.

When the male stop is in the female stop, movement of the shuttle in theshuttle channel can be inhibited.

The male stop distal end can be closer to a center of the shuttle thanthe male stop proximal end.

The male stop can have a hammerhead shape.

The upper jaw 30 can be any jaw disclosed, illustrated, and/orcontemplated herein.

The lower jaw 38 can be any jaw disclosed, illustrated, and/orcontemplated herein.

It is apparent to one skilled in the art that various changes andmodifications can be made to this disclosure, and equivalents employed,without departing from the spirit and scope of the invention. Elementsshown with any variation are exemplary for the specific variation andcan be used on other variations within this disclosure. Any elementsdescribed herein as singular can be pluralized (i.e., anything describedas “one” can be more than one). Any species element of a genus elementcan have the characteristics or elements of any other species element ofthat genus. The above-described configurations, elements or completeassemblies and methods and their elements for carrying out theinvention, and variations of aspects of the invention can be combinedand modified with each other in any combination. Any phrase involving an“A and/or B” construction or similar construction can mean (1) A alone,(2) B alone, (3) A and B together. Any range disclosed can include anysubrange of the range disclosed, for example, a range of 1-10 units caninclude 2-10 units, 8-10 units, or any other subrange.

We claim:
 1. A device disclosed herein.
 2. A system disclosed herein. 3.A method disclosed herein.